Unspecified keratoconjunctivitis, bilateral

This code signifies an inflammatory condition affecting both the cornea and conjunctiva, where the specific type or cause of the inflammation has not been identified. It indicates a generalized inflammation impacting the surface of both eyes.

Apply this code when documentation clearly states "keratoconjunctivitis" affecting both eyes, but lacks further specificity regarding the etiology (e.g., viral, allergic, bacterial, sicca). This is appropriate when the provider has not determined the precise nature of the inflammation.

• Avoid using this code if a more specific type of keratoconjunctivitis (e.g., allergic, viral, sicca) is documented; always code to the highest level of specificity.
• Ensure the documentation explicitly states "bilateral" or indicates involvement of both eyes; otherwise, use a unilateral or unspecified laterality code.
• If the laterality is not documented, default to the unspecified laterality code for keratoconjunctivitis.