ICD-10 Coding for Mitral Regurgitation(I34.0, I05.1)
Complete ICD-10-CM coding and documentation guide for Mitral Regurgitation. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Mitral Regurgitation
I34-I39Primary Range
Nonrheumatic mitral valve disorders
This range includes codes for nonrheumatic mitral valve disorders, including mitral regurgitation.
Rheumatic heart diseases
This range includes codes for rheumatic mitral valve disorders, which are relevant if the etiology is rheumatic.
Congenital malformations of the circulatory system
This range includes codes for congenital mitral valve disorders, applicable if the condition is congenital.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| I34.0 | Nonrheumatic mitral (valve) insufficiency | Use when mitral regurgitation is nonrheumatic and confirmed by echocardiogram. |
|
| I05.1 | Rheumatic mitral insufficiency | Use when mitral regurgitation is due to rheumatic fever. |
|
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 mitral regurgitation
Essential facts and insights about Mitral Regurgitation
Primary ICD-10-CM Codes for mitral regurgitation
Decision Criteria
clinical Criteria
- Nonrheumatic etiology confirmed by echocardiogram
Applicable To
- Nonrheumatic mitral regurgitation
Excludes
- Rheumatic mitral insufficiency (I05.1)
Clinical Validation Requirements
- Echocardiogram showing mitral regurgitation
- Clinical documentation of nonrheumatic etiology
Code-Specific Risks
- Misclassification if rheumatic etiology is present but not documented
Coding Notes
- Ensure documentation specifies nonrheumatic etiology.
I05.1 - Rheumatic mitral insufficiency
Use when mitral regurgitation is due to rheumatic fever.
Applicable To
- Rheumatic mitral regurgitation
Excludes
- Nonrheumatic mitral insufficiency (I34.0)
Clinical Validation Requirements
- History of rheumatic fever
- Echocardiogram showing mitral regurgitation
Coding Notes
Document rheumatic history clearly.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Mitral Regurgitation to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code I34.0.
Impact
Clinical: Inadequate treatment planning., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims.
Mitigation Strategy
Use standardized templates, Include echocardiogram results
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Non-compliance with coding guidelines., Data Quality: Decreases accuracy of health records.
Mitigation Strategy
Ensure documentation specifies etiology to use the correct specific code.
Impact
Risk of audits due to unspecified etiology in mitral regurgitation cases.
Mitigation Strategy
Ensure detailed documentation of etiology in all cases.
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 Mitral Regurgitation, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Mitral Regurgitation
Use these documentation templates to ensure complete and accurate documentation for Mitral Regurgitation. These templates include all required elements for proper coding and billing.
Chronic Severe Mitral Regurgitation
Specialty: CardiologyRequired Elements
- Severity grade
- LVEF values
- Etiology
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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