ICD-10 Coding for Mitral Valve Disease(I34.0, I34.1)
Complete ICD-10-CM coding and documentation guide for Mitral Valve Disease. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Mitral Valve Disease
I34.-Primary Range
Nonrheumatic mitral valve disorders
Covers nonrheumatic mitral valve conditions such as insufficiency, prolapse, and stenosis.
Multiple valve involvement in rheumatic heart disease
Applicable when both mitral and other valves are affected by rheumatic disease.
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 nonrheumatic mitral insufficiency is confirmed by echocardiogram and clinical symptoms. |
|
| I34.1 | Nonrheumatic mitral (valve) prolapse | Use when mitral valve prolapse is confirmed by echocardiogram and clinical symptoms. |
|
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 valve prolapse
Essential facts and insights about Mitral Valve Disease
Primary ICD-10-CM Codes for mitral valve disease
Decision Criteria
clinical Criteria
- Presence of mitral regurgitation on echocardiogram
documentation Criteria
- Explicit mention of nonrheumatic etiology
Applicable To
- Mitral regurgitation
Excludes
- Rheumatic mitral insufficiency (I05.1)
Clinical Validation Requirements
- Echocardiogram showing EROA ≥0.4 cm²
- Symptoms of orthopnea
- BNP >400 pg/mL
Code-Specific Risks
- Misclassification if rheumatic origin is not ruled out.
Coding Notes
- Ensure documentation specifies nonrheumatic origin to avoid incorrect coding.
I34.1 - Nonrheumatic mitral (valve) prolapse
Use when mitral valve prolapse is confirmed by echocardiogram and clinical symptoms.
Applicable To
- Mitral valve prolapse syndrome
Excludes
- Rheumatic mitral prolapse (I05.8)
Clinical Validation Requirements
- Echocardiogram showing >2mm leaflet displacement
- Symptoms of palpitations
- Normal RF/ASO levels
Coding Notes
Ensure documentation specifies nonrheumatic origin and absence of systemic connective tissue disorders.
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 Valve Disease to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code I34.0.
Impact
Clinical: Leads to incorrect treatment plans., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials or reduced reimbursement.
Mitigation Strategy
Always document etiology in clinical notes., Use lab results to confirm nonrheumatic origin.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use Q87.4 instead when Marfan's syndrome is present.
Impact
Reimbursement: Potential for reduced reimbursement due to lack of specificity., Compliance: Failure to meet specificity requirements., Data Quality: Loss of detailed clinical information.
Mitigation Strategy
Use I34.0 for specified mitral insufficiency.
Impact
Inadequate documentation of etiology can lead to audit risks.
Mitigation Strategy
Ensure all clinical notes specify the etiology of mitral valve disorders.
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 Valve Disease, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Mitral Valve Disease
Use these documentation templates to ensure complete and accurate documentation for Mitral Valve Disease. These templates include all required elements for proper coding and billing.
Nonrheumatic Mitral Valve Prolapse
Specialty: CardiologyRequired Elements
- Echocardiogram findings
- Clinical symptoms
- Nonrheumatic etiology confirmation
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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