Is H11.04 a billable ICD-10-CM code?

No. H11.04 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does H11.04 sit in the tabular list?

Diseases of the eye and adnexa (H00-H59), in the block Disorders of conjunctiva (H10-H11).

What cannot be coded together with H11.04?

H11.04 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above H11.04 (H11.0, H11) and apply to it just the same.

H11.04

H11.04 — Peripheral pterygium of eye, stationary

Non-billable headerICD-10-CM

H11.04 is a non-billable header ICD-10-CM code for peripheral pterygium of eye, stationary. It cannot be billed on its own: choose one of the more specific child codes below.

Excludes1 inherited from the categories above H11.04

These are not written on H11.04, but they bind it: a note on a category applies to every code beneath it. Billing H11.04 with anything listed here is a denial.

Written on H11.0 — Pterygium of eye

pseudopterygium (H11.81-)

Written on H11 — Other disorders of conjunctiva

keratoconjunctivitis (H16.2-)

Risk adjustment

H11.04 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Code history

H11.04 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Code to one of these instead H11.04

4 child codes. Green means billable.

Related codes at this level

Codes that share H11.0. If H11.04 is not quite right, the correct code is usually one of these.

Questions about H11.04

Is H11.04 a billable ICD-10-CM code?: No. H11.04 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does H11.04 sit in the tabular list?: Diseases of the eye and adnexa (H00-H59), in the block Disorders of conjunctiva (H10-H11).
What cannot be coded together with H11.04?: H11.04 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above H11.04 (H11.0, H11) and apply to it just the same.