H11.153 ICD-10-CM Code: Pinguecula, bilateral

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for H11.153 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on H11.153 itself; “inherited from” names the category or block whose note applies here.

Coder workflow for H11.153

MedCoder structured workflow — derived from this code’s own official record

Before you code H11.153

1. Laterality is coded in this family. Confirm the side documented — right, left, or bilateral — and select the matching code (this page’s code: bilateral). The unspecified-side code applies only when the record states no side. Laterality is assigned from the documented side; where a bilateral code exists and both sides are documented, it is used instead of two unilateral codes (Guidelines I.B.13).

   See the relationships section · Guide: Laterality coding →

2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with H11.153. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

   See the official tabular notes

Choose the right path

1. Does the documentation support a condition named in H11.153’s Excludes1 note?
   Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
   No → Continue.

   ReviewH10.81, H16.2

2. Is the side documented?
   Yes → Select the code for the documented side (or the bilateral code when both sides are documented and one exists).
   No → Use the unspecified-side code only when the record states no side; a query is the alternative.

Consider H11.153. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement

Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

Laterality

Right, left or bilateral as documented; unspecified only when the record states no side (Guidelines I.B.13).

Official instructions as workflow

• Excludes1 — check before selecting H11.153(2 notes)

  Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with H11.153: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

  CompareH10.81, H16.2

  See the official tabular notes · Guidelines I.A.12.a

• Excludes2 — not part of H11.153(1 note)

  Coding workflow: The conditions named in this note are not included in H11.153. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

  CompareH11.81

  See the official tabular notes · Guidelines I.A.12.b

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Don’t confuse H11.153 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of H11.153 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

• H10.81— Excludes1 conflict (Excludes1 — generally not reported together)

  Not coded here — the tabular list excludes this pair for the same encounter.

  Not reported together with this code, except where the two conditions are documented as unrelated.

  What moves you there: Documentation of pingueculitis moves the case to H10.81; the two are not reported together unless documented as unrelated.

  Full comparison: H11.153 vs H10.81 →

• H16.2— Excludes1 conflict (Excludes1 — generally not reported together)

  Not coded here — the tabular list excludes this pair for the same encounter.

  Not reported together with this code, except where the two conditions are documented as unrelated.

  What moves you there: Documentation of keratoconjunctivitis moves the case to H16.2; the two are not reported together unless documented as unrelated.

  Full comparison: H11.153 vs H16.2 →

• H11.159— Specificity relationship (Review)

  Overlapping diagnoses in the same category.

  Overlapping codes in the same category — the documentation decides which is the more specific fit.

  What moves you there: A record that documents no more than “Pinguecula, unspecified eye” takes H11.159; specificity in the record moves it back here.

  Full comparison: H11.153 vs H11.159 →

• H11.81— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of pseudopterygium adds H11.81; it is not part of this code and both may be reported when both are documented.

  Full comparison: H11.153 vs H11.81 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

1. Laterality is coded in this family. Confirm the documented side matches the code — the opposite-side siblings are in the relationships section. See the opposite-side sibling codes
2. 2 Excludes1 entries — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
3. 1 Excludes2 entry — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

• No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name H11.153 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Excludes1 note: H10.81 — Pingueculitis (via H11.15.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 2 MS-DRGs: DRG 124 (MDC 02), DRG 125 (MDC 02).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):EYE001 — Cornea and external disease (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Cornea and external disease).

+809 more

Contextual Map

Every relationship of H11.153 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run H11.153 with this related code in Claim Check

Hierarchy

• H00-H59 — Chapter 7: Diseases of the Eye and Adnexa (H00-H59) (H00-H59)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H10-H11 — Disorders of conjunctiva[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Referenced by Excludes1 notes

• H10.81 — Pingueculitis[Excludes1](via H11.15.-): “pinguecula (H11.15-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

• EYE001 — Cornea and external disease[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

MS-DRG Grouper

• DRG 124 — OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT[MS-DRG]: “OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT (MDC 02)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 125 — OTHER DISORDERS OF THE EYE WITHOUT MCC[MS-DRG]: “OTHER DISORDERS OF THE EYE WITHOUT MCC (MDC 02)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

MDC crossing

• MDC 02 — Diseases and Disorders of the Eye[MDC crossing]: “Diseases and Disorders of the Eye — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 1,200 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Nearest codes (40)

• H11 — Other disorders of conjunctiva[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H11.113 — Conjunctival deposits, bilateral[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H11.119 — Conjunctival deposits, unspecified eye[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H11.12 — Conjunctival concretions[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H11.121 — Conjunctival concretions, right eye[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H11.122 — Conjunctival concretions, left eye[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H11.123 — Conjunctival concretions, bilateral[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• H11.129 — Conjunctival concretions, unspecified eye[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• and 32 more

Change history

• FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data

CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page

Claim edits Official source data

CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page

Inpatient payment groups Official source data

CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page

Change history and date-of-service validity Official source data

CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page

Comparisons, relationships and the contextual map MedCoder structured relationship

Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears

Summary and FAQ answers MedCoder explanation

Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Nearest Codes in This Family

Official ICD-10-CM classifications closest to H11.153 in its code family, with their registry titles.

• H11.143 — Conjunctival xerosis, unspecified, bilateral
• H11.149 — Conjunctival xerosis, unspecified, unspecified eye
• H11.15 — Pinguecula
• H11.151 — Pinguecula, right eye
• H11.152 — Pinguecula, left eye
• H11.159 — Pinguecula, unspecified eye
• H11.2 — Conjunctival scars
• H11.21 — Conjunctival adhesions and strands (localized)
• H11.211 — Conjunctival adhesions and strands (localized), right eye
• H11.212 — Conjunctival adhesions and strands (localized), left eye

View all codes in the H11 family