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ICD-10 Guide
ICD-10 CodesH16.131

H16.131

Billable

Photokeratitis, right eye

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 H16.131 is a billable code used to indicate a diagnosis of photokeratitis, right eye.

Key Diagnostic Point:

Photokeratitis, commonly referred to as 'snow blindness,' is an acute condition resulting from excessive exposure to ultraviolet (UV) light, primarily affecting the cornea of the right eye. Clinically, it presents with symptoms such as severe pain, redness, tearing, and blurred vision, often occurring within hours of exposure. The cornea, which is the transparent front part of the eye, becomes inflamed and damaged due to the UV radiation, leading to epithelial cell death and subsequent symptoms. The condition can progress rapidly, and if left untreated, may result in complications such as corneal scarring or infection. Diagnosis is typically made through patient history and clinical examination, where signs of corneal edema and punctate keratitis may be observed. Treatment involves symptomatic relief with analgesics, topical lubricants, and sometimes corticosteroids to reduce inflammation. Protective eyewear is crucial in preventing recurrence. Understanding the anatomy involved, particularly the cornea and its response to UV exposure, is essential for effective management and prevention of this condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Moderate, as symptoms can mimic other ocular conditions.
  • Treatment complexity: Moderate, requiring both symptomatic and preventive measures.
  • Documentation requirements: Requires detailed patient history and clinical findings.
  • Coding specificity: Specific to photokeratitis of the right eye, which aids in precise coding.

Audit Risk Factors

  • Common coding errors: Misidentifying the affected eye or confusing with other keratitis types.
  • Documentation gaps: Incomplete patient history or lack of detailed examination findings.
  • Billing challenges: Potential denials due to insufficient documentation supporting the diagnosis.

Specialty Focus

Medical Specialties

Ophthalmology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Primary Care

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related ICD-10 Codes

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Photokeratitis has significant clinical implications, particularly in populations exposed to high UV environments, such as outdoor workers or those in high-altitude areas. The condition can lead to increased healthcare utilization due to acute presentations and potential complications. Understanding its epidemiology is crucial for developing preventive measures and quality improvement initiatives aimed at reducing incidence rates and improving patient outcomes.

ICD-9 vs ICD-10

Photokeratitis has significant clinical implications, particularly in populations exposed to high UV environments, such as outdoor workers or those in high-altitude areas. The condition can lead to increased healthcare utilization due to acute presentations and potential complications. Understanding its epidemiology is crucial for developing preventive measures and quality improvement initiatives aimed at reducing incidence rates and improving patient outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is clearly supported by the documentation, particularly in cases of acute presentation. Common denials may arise from insufficient documentation or misclassification of the condition. Best practices include thorough documentation of patient history, clinical findings, and treatment plans, as well as ensuring that the correct modifiers are applied when necessary to reflect the specific eye affected.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for H00-H99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for H00-H99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by H16.131?

H16.131 specifically covers photokeratitis affecting the right eye, which is characterized by corneal inflammation due to UV exposure. It does not include other forms of keratitis or ocular surface disorders.

When should H16.131 be used instead of related codes?

H16.131 should be used when the diagnosis is confirmed as photokeratitis of the right eye, particularly when symptoms and clinical findings align with this specific condition, differentiating it from other keratitis types.

What documentation supports H16.131?

Documentation should include a detailed patient history of UV exposure, clinical examination findings indicating corneal damage, and any treatment provided. This may include visual acuity tests and assessments of corneal integrity.