H11.001 — Unspecified pterygium of right eye
Is H11.001 billable?
Yes, but H11.001 is an unspecified code. H11.001 is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, H11.001 is an unspecified or catch-all code. Payers apply additional scrutiny to unspecified codes and many deny them when the medical record supports a more specific option, so check the documentation before selecting H11.001 — the more specific alternatives are listed below.
H11.001 at a glance
| Code | H11.001 |
|---|---|
| Description | Unspecified pterygium of right eye |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
Which MS-DRGs does H11.001 group to?
H11.001 sits in MDC 02 and helps define the logic of 2 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 124Other Disorders of the Eye with MCC or Thrombolytic Agentmedical
- 125Other Disorders of the Eye without MCCmedical
How is H11.001 listed in the Alphabetic Index?
The Alphabetic Index lists these routes under H11.00, the nearest indexed parent of H11.001. Use them to find the family, then select the specific code.
- Pterygium (eye)
Excludes1 — never code together — inherited from H11
The conditions below can never be reported together with H11.001 on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
- keratoconjunctivitis (H16.2-)
Excludes1 — never code together — inherited from H11.0
The conditions below can never be reported together with H11.001 on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
- pseudopterygium (H11.81-)
Excludes2 — not included here — inherited from Chapter 7
The conditions below are not part of H11.001, but a patient may have both at the same time. When documentation supports it, H11.001 and the excluded code may both be reported.
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
- diabetes mellitus related eye conditions (E09.3-, E10.3-, E11.3-, E13.3-)
- endocrine, nutritional and metabolic diseases (E00-E88)
- injury (trauma) of eye and orbit (S05.-)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
- syphilis related eye disorders (A50.01, A50.3-, A51.43, A52.71)
How long has H11.001 existed?
H11.001 has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.