ICD-10 Coding for Aortic Regurgitation(I35.1, I06.1)
Complete ICD-10-CM coding and documentation guide for Aortic Regurgitation. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Aortic Regurgitation
I35-I35.9Primary Range
Nonrheumatic aortic valve disorders
This range includes codes for nonrheumatic aortic regurgitation and related conditions.
Rheumatic aortic valve disorders
This range is used for rheumatic causes of aortic regurgitation.
Congenital malformations of aortic valve
This range includes congenital causes of aortic regurgitation.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| I35.1 | Nonrheumatic aortic (valve) insufficiency | Use when nonrheumatic aortic regurgitation is documented. |
|
| I06.1 | Rheumatic aortic insufficiency | Use when rheumatic etiology is documented. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for nonrheumatic aortic regurgitation
Essential facts and insights about Aortic Regurgitation
Primary ICD-10-CM Codes for aortic regurgitation
Decision Criteria
clinical Criteria
- Nonrheumatic etiology confirmed by clinical documentation.
documentation Criteria
- Severity of regurgitation documented with echocardiogram findings.
Applicable To
- Nonrheumatic aortic regurgitation
Excludes
- Rheumatic aortic insufficiency (I06.1)
Clinical Validation Requirements
- Echocardiogram showing regurgitant volume ≥60 mL/beat
- Effective regurgitant orifice (ERO) ≥0.30 cm²
Code-Specific Risks
- Ensure nonrheumatic etiology is documented to avoid miscoding.
Coding Notes
- Ensure to document the etiology and severity of regurgitation.
I06.1 - Rheumatic aortic insufficiency
Use when rheumatic etiology is documented.
Applicable To
- Rheumatic aortic regurgitation
Excludes
- Nonrheumatic aortic insufficiency (I35.1)
Clinical Validation Requirements
- History of rheumatic fever or rheumatic heart disease
Coding Notes
Document history of rheumatic fever or heart disease.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Aortic Regurgitation to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code I35.1.
Impact
Clinical: Impacts treatment decisions., Regulatory: Non-compliance with coding standards., Financial: Potential for incorrect reimbursement.
Mitigation Strategy
Ensure echocardiogram findings are included in documentation.
Impact
Reimbursement: Incorrect DRG assignment may affect reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Impacts accuracy of clinical data.
Mitigation Strategy
Ensure documentation specifies nonrheumatic etiology.
Impact
Failure to document etiology can lead to incorrect coding.
Mitigation Strategy
Educate providers on the importance of documenting etiology.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Aortic Regurgitation, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Aortic Regurgitation
Use these documentation templates to ensure complete and accurate documentation for Aortic Regurgitation. These templates include all required elements for proper coding and billing.
Cardiology Consult for Aortic Regurgitation
Specialty: CardiologyRequired Elements
- Patient history
- Echocardiogram findings
- Severity of regurgitation
- Etiology
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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