ICD-10 Coding for Mitral Valve Regurgitation(I34.0, I05.1)
Complete ICD-10-CM coding and documentation guide for Mitral Valve Regurgitation. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Mitral Valve Regurgitation
I34-I39Primary Range
Nonrheumatic mitral valve disorders
This range includes codes for nonrheumatic mitral valve disorders, which are the most common forms of mitral valve regurgitation.
Rheumatic heart diseases
This range includes codes for rheumatic mitral valve disorders, which are less common but clinically significant.
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 documentation specifies nonrheumatic etiology without structural abnormalities. |
|
| I05.1 | Rheumatic mitral valve insufficiency | Use when documentation specifies rheumatic etiology. |
|
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 regurgitation
Essential facts and insights about Mitral Valve Regurgitation
Primary ICD-10-CM Codes for mitral valve regurgitation
Decision Criteria
clinical Criteria
- Nonrheumatic etiology confirmed by echocardiogram
Applicable To
- Degenerative mitral valve regurgitation
- Functional mitral regurgitation
Excludes
- Rheumatic mitral valve disorders (I05.1)
Clinical Validation Requirements
- Echocardiogram showing regurgitant jet
- Left ventricular ejection fraction
- Clinical symptoms of heart failure
Code-Specific Risks
- Assuming nonrheumatic without documentation
- Missing severity documentation
Coding Notes
- Ensure documentation specifies nonrheumatic cause to avoid defaulting to unspecified codes.
I05.1 - Rheumatic mitral valve insufficiency
Use when documentation specifies rheumatic etiology.
Applicable To
- Chronic rheumatic mitral insufficiency
Excludes
- Nonrheumatic mitral valve disorders (I34.0)
Clinical Validation Requirements
- History of rheumatic fever
- Echocardiogram showing commissural fusion
Coding Notes
Ensure rheumatic history is documented to support code selection.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Heart failure, unspecified
I50.9Differential 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 Mitral Valve 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: Potential coding audits, Financial: Incorrect reimbursement
Mitigation Strategy
Use echocardiogram findings to document severity., Include clinical symptoms in the note.
Impact
Reimbursement: Incorrect DRG assignment, Compliance: Potential audit risk, Data Quality: Inaccurate clinical data
Mitigation Strategy
Query for clarification on etiology if not specified.
Impact
Lack of specific etiology documentation can lead to incorrect coding.
Mitigation Strategy
Ensure clear documentation of etiology in all patient records.
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 Regurgitation, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Mitral Valve Regurgitation
Use these documentation templates to ensure complete and accurate documentation for Mitral Valve Regurgitation. These templates include all required elements for proper coding and billing.
Nonrheumatic mitral regurgitation with heart failure
Specialty: CardiologyRequired Elements
- Etiology of mitral regurgitation
- Severity of regurgitation
- Heart failure symptoms
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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