ICD-10 Coding for Pterygium(H11.051, H11.052, H11.053, H11.061, H11.062, H11.063)
Complete ICD-10-CM coding and documentation guide for Pterygium. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Pterygium
H11.0-H11.9Primary Range
Disorders of conjunctiva
This range includes pterygium and related conjunctival disorders.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| H11.051 | Pterygium, right eye | Use when documenting pterygium affecting the right eye. |
|
| H11.052 | Pterygium, left eye | Use when documenting pterygium affecting the left eye. |
|
| H11.053 | Pterygium, bilateral | Use when documenting pterygium affecting both eyes. |
|
| H11.061 | Recurrent pterygium, right eye | Use when documenting recurrent pterygium affecting the right eye. |
|
| H11.062 | Recurrent pterygium, left eye | Use when documenting recurrent pterygium affecting the left eye. |
|
| H11.063 | Recurrent pterygium, bilateral | Use when documenting recurrent pterygium affecting both eyes. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for pterygium
Essential facts and insights about Pterygium
Primary ICD-10-CM Codes for pterygium
Decision Criteria
clinical Criteria
- Presence of pterygium on the right eye confirmed by examination.
Applicable To
- Peripheral pterygium, right eye
Excludes
- Pinguecula (H11.15)
Clinical Validation Requirements
- Slit-lamp examination showing pterygium crossing the limbus
- Photographic evidence if vision-threatening
Code-Specific Risks
- Ensure laterality is correctly documented.
Coding Notes
- Ensure documentation specifies laterality and recurrence if applicable.
H11.052 - Pterygium, left eye
Use when documenting pterygium affecting the left eye.
Applicable To
- Peripheral pterygium, left eye
Excludes
- Pinguecula (H11.15)
Clinical Validation Requirements
- Slit-lamp examination showing pterygium crossing the limbus
- Photographic evidence if vision-threatening
Coding Notes
Ensure documentation specifies laterality and recurrence if applicable.
H11.053 - Pterygium, bilateral
Use when documenting pterygium affecting both eyes.
Applicable To
- Peripheral pterygium, bilateral
Excludes
- Pinguecula (H11.15)
Clinical Validation Requirements
- Slit-lamp examination showing pterygium crossing the limbus in both eyes
- Photographic evidence if vision-threatening
Coding Notes
Ensure documentation specifies laterality and recurrence if applicable.
H11.061 - Recurrent pterygium, right eye
Use when documenting recurrent pterygium affecting the right eye.
Applicable To
- Recurrent peripheral pterygium, right eye
Excludes
- Pinguecula (H11.15)
Clinical Validation Requirements
- Documented history of prior pterygium surgery
- Slit-lamp examination showing recurrence
Coding Notes
Ensure documentation specifies laterality and recurrence if applicable.
H11.062 - Recurrent pterygium, left eye
Use when documenting recurrent pterygium affecting the left eye.
Applicable To
- Recurrent peripheral pterygium, left eye
Excludes
- Pinguecula (H11.15)
Clinical Validation Requirements
- Documented history of prior pterygium surgery
- Slit-lamp examination showing recurrence
Coding Notes
Ensure documentation specifies laterality and recurrence if applicable.
H11.063 - Recurrent pterygium, bilateral
Use when documenting recurrent pterygium affecting both eyes.
Applicable To
- Recurrent peripheral pterygium, bilateral
Excludes
- Pinguecula (H11.15)
Clinical Validation Requirements
- Documented history of prior pterygium surgery
- Slit-lamp examination showing recurrence in both eyes
Coding Notes
Ensure documentation specifies laterality and recurrence if applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Pinguecula
H11.15Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Pterygium to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code H11.051.
Impact
Clinical: Inadequate clinical records for future reference., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials or reduced reimbursement.
Mitigation Strategy
Use templates to ensure all required elements are documented., Regular training on documentation standards.
Impact
Reimbursement: Incorrect coding may lead to claim denials., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate data on surgical procedures.
Mitigation Strategy
Use 65426 for excision with any graft type.
Impact
Reimbursement: Claims may be denied for lack of specificity., Compliance: Failure to meet ICD-10 coding standards., Data Quality: Inaccurate patient records.
Mitigation Strategy
Always append the correct laterality digit.
Impact
Using incorrect codes for pterygium procedures can lead to audits.
Mitigation Strategy
Regular coding audits and staff training.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Pterygium, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Pterygium
Use these documentation templates to ensure complete and accurate documentation for Pterygium. These templates include all required elements for proper coding and billing.
Pterygium excision with graft
Specialty: OphthalmologyRequired Elements
- Procedure details
- Graft type
- Laterality
- Complications
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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