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D31.10

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🧬ICD-10-CM Code: D31.10 - Benign neoplasm of unspecified cornea

Quick Reference

Code: D31.10
Short Description: Benign neoplasm of unspecified cornea
Category: D31 - Benign neoplasm of eye and adnexa
Chapter: D - Neoplasms (D00-D49)
HIPAA Valid: ✅ Yes (valid for billing/transactions)

Description

Short Description

Benign (non-cancerous) tumor or growth of the cornea, laterality not specified.

Full Description

D31.10 represents a benign neoplasm affecting the cornea without specification of which eye (right or left) is involved. The cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber. Benign neoplasms in this location are non-malignant growths that do not spread to other parts of the body but may still require treatment if they affect vision or cause discomfort.

Common benign corneal neoplasms include:

  • Dermoid cysts
  • Epithelial inclusion cysts
  • Benign epithelial tumors
  • Limbal dermoids

Hierarchical Classification

ICD-10-CM Structure:

D00-D49: Neoplasms
  └─ D10-D36: Benign neoplasms, except benign neuroendocrine tumors
      └─ D31: Benign neoplasm of eye and adnexa
          └─ D31.1: Benign neoplasm of cornea
              ├─ D31.10: Benign neoplasm of unspecified cornea
              ├─ D31.11: Benign neoplasm of right cornea
              └─ D31.12: Benign neoplasm of left cornea

Same Category (D31.1x - Cornea)

CodeDescription
D31.10Benign neoplasm of unspecified cornea
D31.11Benign neoplasm of right cornea
D31.12Benign neoplasm of left cornea
CodeDescription
D31.00Benign neoplasm of unspecified conjunctiva
D31.20Benign neoplasm of unspecified retina
D31.30Benign neoplasm of unspecified choroid
D31.40Benign neoplasm of unspecified ciliary body
D31.50Benign neoplasm of unspecified lacrimal gland and duct
D31.60Benign neoplasm of unspecified site of unspecified orbit
D31.90Benign neoplasm of unspecified part of unspecified eye

Common Associated CPT Codes

Ophthalmology Evaluation & Management

CPT CodeDescription
92004Ophthalmological services: comprehensive, new patient
92014Ophthalmological services: comprehensive, established patient
92012Ophthalmological services: intermediate, established patient
99213-99215Office visits, established patient (varying complexity)

Diagnostic Procedures

CPT CodeDescription
92285External ocular photography
76514Ophthalmic ultrasound, diagnostic; corneal pachymetry
92133Scanning computerized ophthalmic diagnostic imaging, anterior segment

Surgical Procedures (if treatment required)

CPT CodeDescription
65410Biopsy of cornea
65426Excision or transposition of pterygium; with graft
65600Multiple punctures of anterior cornea (e.g., for corneal erosion)
68110Excision of lesion, conjunctiva; up to 1 cm
68115Excision of lesion, conjunctiva; over 1 cm

RVU Information

Note: RVUs (Relative Value Units) and wRVUs (work RVUs) apply to CPT procedure codes, not ICD-10 diagnosis codes.

  • ICD-10 codes (like D31.10) are diagnosis codes used for documenting medical conditions
  • CPT codes are procedure codes that have associated RVU values for physician payment
  • D31.10 itself has no RVU value

For RVU information, refer to the specific CPT codes used to evaluate or treat the condition (see CPT codes section above).

HCC (Hierarchical Condition Category) Information

HCC Status: ❌ NOT an HCC Code

D31.10 does not map to any HCC category. The CMS-HCC model focuses on chronic, serious conditions that predict future healthcare costs. Benign neoplasms of the eye generally do not qualify for HCC risk adjustment.

HCC Mapping Summary

  • CMS-HCC Model V24: Not mapped
  • CMS-HCC Model V28: Not mapped
  • HHS-HCC Model: Not mapped

Note: HCC codes are primarily used for:

  • Medicare Advantage risk adjustment
  • Quality payment programs
  • Predicting healthcare resource utilization

Benign neoplasms typically do not meet HCC criteria unless they cause significant complications or require extensive ongoing management.

Clinical Considerations

Documentation Requirements

For optimal coding specificity:

  1. Specify laterality when known:

    • Use D31.11 for right cornea
    • Use D31.12 for left cornea
    • Use D31.10 only when laterality is truly unknown or not documented

  2. Document lesion characteristics:

    • Size and location on cornea
    • Impact on visual acuity
    • Symptoms (pain, foreign body sensation, photophobia)
    • Duration and progression

  3. Include relevant diagnostic findings:

    • Slit-lamp examination results
    • Imaging findings (if performed)
    • Biopsy results (if obtained)

Differential Diagnosis

Consider and rule out:

  • Pterygium (H11.0-)
  • Pinguecula (H11.15-)
  • Corneal dystrophy (H18.5-)
  • Corneal scar/opacity (H17.-)
  • Limbal stem cell deficiency
  • Malignant neoplasms (C69.1-)

Treatment Considerations

  • Observation for small, asymptomatic lesions
  • Excisional biopsy for diagnosis confirmation
  • Surgical removal if affecting vision or cosmesis
  • Regular monitoring for growth or changes
  • Referral to ophthalmology/corneal specialist

Coding Guidelines

ICD-10-CM Official Guidelines

  • Use the most specific code available
  • Code laterality when documented (D31.11 or D31.12 preferred over D31.10)
  • Code any associated symptoms separately if clinically significant
  • Do not assign a benign neoplasm code as primary diagnosis if the patient is being treated for a malignant neoplasm

Coding Tips

✅ DO:

  • Verify the pathology report to confirm benign nature
  • Code to highest level of specificity based on documentation
  • Query provider for laterality if not documented
  • Use additional codes for complications or associated conditions

❌ DON’T:

  • Assume laterality - code as unspecified if not documented
  • Use this code for malignant corneal neoplasms (use C69.1-)
  • Code lesions of the conjunctiva as corneal lesions
  • Use for corneal degenerations or dystrophies

Reimbursement Notes

General Billing Information

  • D31.10 is HIPAA-compliant for electronic transactions
  • Must be supported by documentation in medical record
  • May require prior authorization for surgical procedures
  • Consider medical necessity documentation for diagnostic procedures

Documentation for Medical Necessity

Ensure documentation includes:

  1. Patient symptoms and complaints
  2. Physical examination findings
  3. Impact on visual function
  4. Clinical rationale for diagnostic testing
  5. Treatment plan and follow-up

Quick Reference Card

┌─────────────────────────────────────────┐
│ ICD-10: D31.10                          │
│ Benign neoplasm of unspecified cornea  │
├─────────────────────────────────────────┤
│ ✅ HIPAA Valid                          │
│ ❌ Not HCC                              │
│ ❌ No RVU (diagnosis code)              │
│                                         │
│ More Specific Codes:                    │
│ • D31.11 - Right cornea                 │
│ • D31.12 - Left cornea                  │
│                                         │
│ Common CPT Pairs:                       │
│ • 92004/92014 - Eye exam                │
│ • 65410 - Corneal biopsy                │
│ • 92133 - Anterior segment imaging      │
└─────────────────────────────────────────┘

References & Resources

Official Resources

  • ICD-10-CM Official Guidelines for Coding and Reporting
  • CMS ICD-10-CM Code Lookup Tool
  • AMA CPT Code Set

Professional Organizations

  • American Academy of Ophthalmology (AAO)
  • American Society of Cataract and Refractive Surgery (ASCRS)

Version Information

Document Created: February 2026
ICD-10-CM Version: FY 2026
Last Updated: 2026-02-09

Notes Section

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Tags: ICD10 ophthalmology benign-neoplasm cornea eye coding D31

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