🧬ICD-10 CM H11.31 — Conjunctival Hemorrhage, Right Eye

Code Overview

ICD-10 CM H11.31 is a billable ICD-10-CM diagnosis code representing conjunctival hemorrhage of the right eye, commonly referred to clinically as a subconjunctival hemorrhage (SCH). This code falls under the category H11 — Other Disorders of Conjunctiva within Chapter 7 — Diseases of the Eye and Adnexa (H00-H59). It does not carry a 7th character extension, and laterality is captured at the 5th character level.

Conjunctival hemorrhage involves the rupture of small conjunctival blood vessels resulting in blood accumulating in the subconjunctival space — the potential space between the transparent conjunctiva and the underlying sclera. Despite its dramatic appearance, the condition is most commonly benign and self-limiting but may indicate an underlying systemic condition requiring further workup when recurrent or bilateral.

Full Code Description

Element	Detail
Full Code	H11.31
Description	Conjunctival hemorrhage, right eye
Synonym	Subconjunctival hemorrhage, right eye
Billable	Yes
Chronic Condition	No — acute/episodic condition
ICD-9-CM Equivalent	372.72 — Conjunctival hemorrhage
Valid FY	FY2025 (Oct 1, 2024 - Sep 30, 2025)
Chapter	7 — Diseases of the Eye and Adnexa
Block	H10-H11 — Disorders of Conjunctiva
CCSR Category	EYE001 — Cornea and External Disease

Clinical Description

A subconjunctival hemorrhage occurs when one or more of the small, fragile blood vessels on the surface of the eye rupture, leaking blood into the subconjunctival space. Because the conjunctiva is transparent, the pooled blood is highly visible as a bright red or dark red patch on the white of the eye (sclera), but it is contained and does not affect intraocular pressure or visual acuity.

Etiology and precipitating factors include:

Spontaneous / idiopathic — the most common cause; often occurs overnight or upon waking
Valsalva maneuver — vigorous coughing, sneezing, straining, vomiting, heavy lifting, or childbirth
Trauma — blunt eye trauma, conjunctival foreign body, excessive eye rubbing
Hypertension — recurrent SCH may prompt blood pressure workup
Coagulopathies / bleeding disorders — thrombocytopenia, hemophilia, von Willebrand disease
Anticoagulant or antiplatelet therapy — warfarin, aspirin, clopidogrel, NSAIDs, fish oil supplements
Conjunctival vascular fragility — aging, diabetes mellitus, arteriosclerosis
Contact lens overuse or improper fit
Post-surgical — following intraocular or orbital surgery, including retrobulbar anesthesia injection
Infectious — leptospirosis, hemorrhagic fever (rare but important in international travel contexts)

Clinical presentation:

Painless, bright red patch on the conjunctiva, sharply demarcated
No discharge, no photophobia, normal visual acuity
Self-resolving over 1-3 weeks as blood reabsorbs, often changing color (red → orange → yellow)
May enlarge slightly in the first 24-48 hours before resolution begins

When to be concerned (beyond benign SCH):

Recurrent episodes without clear precipitant — evaluate for hypertension, bleeding diathesis, anticoagulation
Bilateral simultaneous occurrence — consider systemic cause
Associated trauma with deep penetration concern — rule out open globe injury
Posterior extension not visible — rule out retrobulbar hemorrhage
Post-operative setting — monitor for wound leak or elevated IOP

Code Structure / Code Tree

H00-H59    Diseases of the Eye and Adnexa
  └── H10-H11    Disorders of Conjunctiva
        └── H11    Other Disorders of Conjunctiva
              │
              ├── H11.0    Pterygium of eye
              ├── H11.1    Conjunctival degenerations and deposits
              ├── H11.2    Conjunctival scars
              │
              ├── H11.3    Conjunctival hemorrhage         ◄ **PARENT CATEGORY**
              │     ├── [[H11.30]]    Conjunctival hemorrhage, unspecified eye
              │     ├── [[H11.31]]    Conjunctival hemorrhage, RIGHT eye    ◄ **YOU ARE HERE**
              │     ├── [[H11.32]]    Conjunctival hemorrhage, left eye
              │     └── [[H11.33]]    Conjunctival hemorrhage, bilateral
              │
              ├── H11.4    Other conjunctival vascular disorders and cysts
              │     ├── [[H11.41]]    Vascular abnormalities of conjunctiva
              │     ├── [[H11.42]]    Conjunctival edema
              │     ├── [[H11.43]]    Conjunctival hyperemia
              │     └── [[H11.44]]    Conjunctival cysts
              │
              ├── H11.5    Conjunctival concretions/pigmentation/xerosis
              └── H11.8    Other specified disorders of conjunctiva

Tip

Laterality Note: H11.31 is a 5-character billable code. Unlike many ophthalmology codes in ICD-10-CM, conjunctival hemorrhage codes do not have a 7th character extension for encounter type (initial/subsequent/sequela). Laterality is the final required specificity element.

Includes / Excludes Notes

Includes (H11.3 Category)

Subconjunctival hemorrhage
Hyposphagma (blood between conjunctiva and sclera)
Conjunctival hemorrhage from any cause unless coded elsewhere (see Excludes below)

Excludes1 (H11 Category Level — Mutually Exclusive)

These codes cannot be reported simultaneously with H11.31:

Code	Description
H16.2-	Keratoconjunctivitis

Tip

The Excludes1 note at the H11 category level means that keratoconjunctivitis should never be coded alongside H11.31. If the conjunctival inflammation is part of a keratoconjunctivitis process, code H16.2- instead.

Excludes2 (Not Included Here — May Be Coded Additionally If Present)

None listed at the H11.3 subcategory level

Important Instructional Notes

Code also any underlying condition contributing to the hemorrhage when documented and clinically relevant (e.g., essential hypertension I10, coagulopathy D68._, anticoagulant use Z79.01)
Traumatic hemorrhage: If the conjunctival hemorrhage is the result of direct trauma, an external cause code from the V00-Y99 range should be added to identify the mechanism of injury
Post-procedural: If the hemorrhage is a complication of an ocular procedure, consider H59._ (intraoperative/postprocedural complications) before defaulting to H11.31
Do not use H11.31 for retinal hemorrhage (H35.6_), vitreous hemorrhage (H43.1_), or hyphema (H21.0_) — these are anatomically distinct structures

HCC (Hierarchical Condition Category) Mapping

H11.31 does NOT map to a CMS-HCC under the CMS-HCC Risk Adjustment Model (V28).

Conjunctival hemorrhage is an acute, episodic, and generally benign condition. It carries no HCC weight in any current risk adjustment model.

HCC Model	HCC Assignment	RAF Impact
CMS-HCC Model V28	Not assigned	No RAF
RxHCC Model	Not assigned	No RAF
HHS-HCC (Marketplace)	Not assigned	No RAF

Tip

Coding Tip: While H11.31 itself generates no HCC, any underlying systemic condition documented as causally related to the hemorrhage may carry significant HCC weight. Hypertension (I10 → HCC none, but important for chronic care), coagulopathy (D68._ → HCC 48 in some models), or malignancy-related thrombocytopenia (D69.59 → potentially HCC-mapped) should always be coded when documented and clinically supported.

MS-DRG Mapping (Inpatient)

When H11.31 is assigned as the principal diagnosis in an inpatient setting, it maps to:

MS-DRG	Description	Trigger
124	Other Disorders of the Eye with MCC	Principal Dx = H11.31 + qualifying MCC
125	Other Disorders of the Eye without MCC	Principal Dx = H11.31, no MCC present

MDC: MDC 02 — Diseases and Disorders of the Eye

Tip

Practical Note: Isolated subconjunctival hemorrhage essentially never drives an inpatient admission on its own. In practice, H11.31 would appear as a secondary diagnosis in the inpatient setting — most commonly when the patient is admitted for a systemic condition (e.g., hypertensive urgency, thrombocytopenic purpura, anticoagulation-related bleeding event) and the SCH is a secondary finding. The systemic condition would serve as the PDx and drive the MS-DRG assignment.

CC/MCC Status:

H11.31 is not classified as a CC or MCC in the MS-DRG system
It will not upgrade a MS-DRG when present as a secondary diagnosis
If the underlying cause (e.g., disseminated intravascular coagulation, severe thrombocytopenia) is the PDx, those codes may carry CC/MCC weight independently

CPT Procedure Codes (Commonly Associated)

Evaluation and Management / Diagnostic

CPT Code	Description	wRVU (approx.)
92002	Ophthalmological exam, new patient, intermediate	1.34
92004	Ophthalmological exam, new patient, comprehensive	2.67
92012	Ophthalmological exam, established patient, intermediate	0.97
92014	Ophthalmological exam, established patient, comprehensive	1.50
99213	Office visit, established patient, low complexity (E/M)	1.30
99214	Office visit, established patient, moderate complexity (E/M)	1.92
99202	Office visit, new patient, low complexity (E/M)	0.93
99203	Office visit, new patient, moderate complexity (E/M)	1.60
92250	Fundus photography (bilateral) — rule out posterior extension	0.46
92285	External ocular photography — document extent of hemorrhage	0.46

Tip

E/M vs. Ophthalmology Exam Codes: For conjunctival hemorrhage presenting to a primary care or urgent care setting, E/M codes (99202-99215) are appropriate. When evaluated by an ophthalmologist or optometrist, ophthalmological exam codes (92002-92014) are used instead. These two code families are mutually exclusive on the same date by the same provider.

Procedures — Rarely Required, but Possible

CPT Code	Description	wRVU (approx.)
65930	Removal of blood clot, anterior segment of eye (only if clot migration causes obstruction)	5.09
68200	Subconjunctival injection (if treating an associated conjunctival condition)	0.95
65091	Evisceration of ocular contents (extreme/rare — only if associated with globe injury)	—

Tip

Practical Note: The overwhelming majority of subconjunctival hemorrhage cases are managed conservatively with observation only — no procedures are performed. Treatment consists of patient reassurance, avoiding aspirin/NSAIDs if not medically necessary, artificial tears for comfort, and cool compresses. Procedure codes are rarely applicable.

Assistant Surgeon Payable?

Procedure	Assistant Surgeon Allowed?
65930 — Blood clot removal, anterior segment	No — procedure does not typically support assistant under CMS guidelines
92004 / 92014 E/M or Eye Exams	No — evaluation services never support assistant surgeon
68200 — Subconjunctival injection	No — minor procedure, assistant not payable

Tip

No procedures commonly associated with H11.31 support assistant surgeon billing. This is consistent with the benign and minor nature of the condition.

Coding Examples

Example 1 — Spontaneous SCH, New Patient, Primary Care

Clinical Scenario: A 58-year-old female presents to her PCP after waking up and noticing a bright red area on the white of her right eye. She denies pain, vision changes, trauma, or discharge. She is on daily aspirin 81mg and lisinopril for hypertension. Examination reveals a well-demarcated subconjunctival hemorrhage, right eye. Blood pressure in office is 148/92. No other ocular or systemic pathology identified. Patient reassured; conservative management.

ICD-10-CM Codes:

H11.31 — Conjunctival hemorrhage, right eye
I10 — Essential (primary) hypertension (code also: relevant contributing systemic condition)
Z79.82 — Long-term (current) use of aspirin (code also: antiplatelet use contributing to hemorrhage)

CPT Codes:

99213 — Office visit, established patient, low complexity

Example 2 — Traumatic SCH, Established Ophthalmology Patient

Clinical Scenario: A 32-year-old male presents to ophthalmology after being struck in the right eye by a racquetball. He has a visible subconjunctival hemorrhage, right eye. Slit lamp exam confirms intact globe; no hyphema, no corneal abrasion. IOP is normal. Visual acuity 20/20 OD.

ICD-10-CM Codes:

H11.31 — Conjunctival hemorrhage, right eye
S00.11XA — Contusion of right eyelid and periocular area, initial encounter (external cause-related trauma code)
W21.11XA — Struck by baseball, initial encounter (external cause — adjust based on actual mechanism; use appropriate sports equipment code)

CPT Codes:

92012 — Ophthalmological exam, established patient, intermediate

Tip

Coder Note: Always append an external cause code from the V00-Y99 range when conjunctival hemorrhage is the result of documented trauma. This supports medical necessity, appeals, and injury-related claim adjudication.

Example 3 — Bilateral SCH in Post-Surgical Patient

Clinical Scenario: A 71-year-old male on warfarin therapy for atrial fibrillation undergoes elective cataract surgery of the left eye (CPT 66984). Postoperatively, he develops a subconjunctival hemorrhage in the left eye and is incidentally noted to have a new small SCH in the right eye as well. INR on day of surgery was 2.4 (therapeutic range). Both hemorrhages are documented in the operative/post-op note.

ICD-10-CM Codes (Post-op encounter):

H11.33 — Conjunctival hemorrhage, bilateral (bilateral is the correct code when both eyes are affected; do not separately code H11.31 and H11.32)
Z79.01 — Long-term (current) use of anticoagulants
I48.91 — Unspecified atrial fibrillation (underlying reason for anticoagulation)
Z98.41 — Cataract extraction status, left eye (post-procedural history)

Tip

Coder Note: When both eyes are affected, use H11.33 (bilateral) rather than coding H11.31 and H11.32 separately. This mirrors ICD-10-CM laterality guidance for conjunctival hemorrhage.

Example 4 — Recurrent SCH with Coagulopathy Workup

Clinical Scenario: A 45-year-old female presents to ophthalmology as a new patient with her third spontaneous SCH in the right eye in 6 months. No trauma, no anticoagulant use. Lab workup ordered reveals mild thrombocytopenia. No visual symptoms. Exam: subconjunctival hemorrhage, right eye; remainder of exam unremarkable.

ICD-10-CM Codes:

H11.31 — Conjunctival hemorrhage, right eye
D69.59 — Other secondary thrombocytopenia (code also: underlying hematologic condition if identified)
Referral to hematology placed

CPT Codes:

92004 — Comprehensive ophthalmological exam, new patient

Key Coding Pitfalls & Tips

Do not confuse with hyphema. Hyphema (H21.0_) is blood in the anterior chamber of the eye — between the cornea and the iris. Conjunctival hemorrhage (H11.3_) is blood superficial to the sclera under the conjunctiva. These are anatomically and clinically distinct; do not interchange.
Do not confuse with retinal or vitreous hemorrhage. H11.31 is strictly a conjunctival (surface) finding. Retinal hemorrhage (H35.6_) and vitreous hemorrhage (H43.1_) are intraocular and far more clinically serious.
Avoid unspecified laterality. H11.30 (unspecified eye) should be avoided when the affected eye is documented. Payers increasingly scrutinize unspecified laterality codes.
Bilateral = H11.33. Do not code H11.31 + H11.32 together when both eyes are affected. Use H11.33 for bilateral involvement.
Code underlying/contributing conditions. Coagulopathy, anticoagulant use, hypertension, and trauma mechanisms should all be captured when documented.
No 7th character needed. Unlike trauma codes or many ophthalmology encounter-type codes, H11.31 does not require or accept a 7th character. The code is complete at 5 characters.
Post-procedural hemorrhage: If the SCH directly follows an ocular procedure, consider whether H59._ (postprocedural complications of eye) is more appropriate than H11.31 before defaulting to the non-complication code.

Code	Description
H11.30	Conjunctival hemorrhage, unspecified eye
H11.32	Conjunctival hemorrhage, left eye
H11.33	Conjunctival hemorrhage, bilateral
H21.00	Hyphema, unspecified eye (blood in anterior chamber — do NOT confuse)
H21.01	Hyphema, right eye
H35.61	Retinal hemorrhage, right eye (intraocular — do NOT confuse)
H43.11	Vitreous hemorrhage, right eye (intraocular — do NOT confuse)
H11.411	Vascular abnormalities of conjunctiva, right eye
H11.431	Conjunctival hyperemia, right eye
S05.01XA	Conjunctival laceration without foreign body, right eye, initial encounter
S05.11XA	Contusion of eyeball and orbital tissues, right eye, initial encounter
D69.59	Other secondary thrombocytopenia
D68.9	Coagulation defect, unspecified
Z79.01	Long-term (current) use of anticoagulants
Z79.82	Long-term (current) use of aspirin
I10	Essential (primary) hypertension
H59.311	Postprocedural hemorrhage of right eye and adnexa following ophthalmologic procedure

Last Reviewed: 2026-02-17 | Source: ICD-10-CM FY2025, CMS PFS, AAO External Disease & Cornea Preferred Practice Pattern

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H11.31

🧬ICD-10 CM H11.31 — Conjunctival Hemorrhage, Right Eye

Code Overview

Full Code Description

Clinical Description

Code Structure / Code Tree

Includes / Excludes Notes

Includes (H11.3 Category)

Excludes1 (H11 Category Level — Mutually Exclusive)

Excludes2 (Not Included Here — May Be Coded Additionally If Present)

Important Instructional Notes

HCC (Hierarchical Condition Category) Mapping

MS-DRG Mapping (Inpatient)

CPT Procedure Codes (Commonly Associated)

Evaluation and Management / Diagnostic

Procedures — Rarely Required, but Possible

Assistant Surgeon Payable?

Coding Examples

Example 1 — Spontaneous SCH, New Patient, Primary Care

Example 2 — Traumatic SCH, Established Ophthalmology Patient

Example 3 — Bilateral SCH in Post-Surgical Patient

Example 4 — Recurrent SCH with Coagulopathy Workup

Key Coding Pitfalls & Tips

Related Codes (Cross-Reference)

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