Phlyctenular keratoconjunctivitis, right eye

This code describes an inflammatory condition affecting the cornea and conjunctiva of the right eye, characterized by the formation of small, nodular lesions called phlyctenules. These lesions are typically a delayed hypersensitivity reaction, often associated with bacterial antigens like Staphylococcus or Mycobacterium tuberculosis.

Apply this code when documentation specifies phlyctenular keratoconjunctivitis affecting the right eye. Supporting documentation should include a physician's diagnosis based on clinical examination, noting the presence of phlyctenules and laterality. This code is appropriate for both initial and subsequent encounters for this condition.

• Ensure laterality is clearly documented; separate codes exist for the left eye and bilateral involvement.
• Do not confuse with other forms of conjunctivitis or keratitis; the presence of phlyctenules is key for this diagnosis.
• Consider coding an underlying infectious cause if identified and documented, such as tuberculosis, as a secondary diagnosis.