ICD-10 Coding for Systolic Murmur(R01.0, R01.1, I35.0)
Complete ICD-10-CM coding and documentation guide for Systolic Murmur. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Systolic Murmur
R01.0-R01.1Primary Range
Cardiac murmurs and other cardiac sounds
This range includes codes for benign and unspecified cardiac murmurs, which are common presentations of systolic murmurs.
Nonrheumatic mitral and aortic valve disorders
This range includes codes for specific valvular heart diseases that can present with systolic murmurs.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| R01.0 | Benign and innocent cardiac murmurs | Use when the murmur is confirmed as benign or innocent, typically in children or young adults. |
|
| R01.1 | Cardiac murmur, unspecified | Use when the murmur's cause is not identified or further investigation is needed. |
|
| I35.0 | Nonrheumatic aortic (valve) stenosis | Use when aortic stenosis is confirmed as the cause of the murmur. |
|
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 systolic murmur
Essential facts and insights about Systolic Murmur
Primary ICD-10-CM Codes for systolic murmur
Decision Criteria
clinical Criteria
- Murmur resolves with positional changes and lacks radiation or thrill.
Applicable To
- Functional murmur
- Innocent murmur
Excludes
- Pathological murmurs
Clinical Validation Requirements
- Normal echocardiogram
- Absence of symptoms such as chest pain or syncope
Code-Specific Risks
- Misclassification as pathological
Coding Notes
- Ensure documentation explicitly states 'benign' or 'innocent' to use this code.
R01.1 - Cardiac murmur, unspecified
Use when the murmur's cause is not identified or further investigation is needed.
Excludes
- Benign murmurs (R01.0)
Clinical Validation Requirements
- Presence of a systolic murmur without a confirmed benign etiology
Coding Notes
R01.1 should be used as a placeholder until further diagnostic clarification.
I35.0 - Nonrheumatic aortic (valve) stenosis
Use when aortic stenosis is confirmed as the cause of the murmur.
Excludes
- Rheumatic aortic stenosis
Clinical Validation Requirements
- Echocardiogram findings: AVA <1.0 cm², Vmax >4 m/s
Coding Notes
Ensure echocardiographic evidence supports the diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Systolic Murmur to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code R01.0.
Impact
Clinical: May lead to inappropriate management decisions., Regulatory: Potential for audit findings due to insufficient documentation., Financial: Risk of claim denials or reduced reimbursement.
Mitigation Strategy
Use structured templates for murmur documentation., Educate providers on the importance of detailed murmur descriptions.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Confirm with the provider if the murmur is benign and use R01.0 instead.
Impact
High frequency of R01.1 usage without subsequent diagnostic clarification.
Mitigation Strategy
Implement regular chart audits to ensure follow-up on unspecified murmurs.
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 Systolic Murmur, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Systolic Murmur
Use these documentation templates to ensure complete and accurate documentation for Systolic Murmur. These templates include all required elements for proper coding and billing.
Evaluation of a systolic murmur in a child
Specialty: PediatricsRequired Elements
- Murmur description (grade, timing, location)
- Associated symptoms
- Diagnostic tests ordered
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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