ICD-10 Coding for Tricuspid Insufficiency(I07.1, I36.1)
Complete ICD-10-CM coding and documentation guide for Tricuspid Insufficiency. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Tricuspid Insufficiency
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| I07.1 | Rheumatic tricuspid insufficiency | Use when tricuspid insufficiency is due to rheumatic heart disease. |
|
| I36.1 | Nonrheumatic tricuspid insufficiency | Use when tricuspid insufficiency is due to nonrheumatic causes such as device complications. |
|
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 rheumatic tricuspid insufficiency
Essential facts and insights about Tricuspid Insufficiency
Primary ICD-10-CM Codes for tricuspid insufficiency
Decision Criteria
clinical Criteria
- Presence of rheumatic fever history and echocardiographic findings
Applicable To
- Rheumatic tricuspid valve regurgitation
Excludes
- Nonrheumatic tricuspid insufficiency (I36.1)
Clinical Validation Requirements
- History of rheumatic fever
- Valve thickening or calcification on echocardiogram
- Elevated ASO or anti-DNase B titers
Code-Specific Risks
- Incorrectly coding nonrheumatic cases as rheumatic
Coding Notes
- Ensure documentation specifies 'rheumatic' to use this code.
I36.1 - Nonrheumatic tricuspid insufficiency
Use when tricuspid insufficiency is due to nonrheumatic causes such as device complications.
Applicable To
- Functional tricuspid regurgitation
Excludes
- Rheumatic tricuspid insufficiency (I07.1)
Clinical Validation Requirements
- Echocardiographic evidence of tricuspid regurgitation
- No history of rheumatic fever
- Presence of device-related complications
Coding Notes
Ensure documentation excludes rheumatic etiology.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Right heart failure
I50.81Primary pulmonary hypertension
I27.0Other specified complications of cardiac and vascular prosthetic devices, implants and grafts
T82.898ADifferential 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 Tricuspid Insufficiency to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code I07.1.
Impact
Clinical: Inadequate treatment planning., Regulatory: Non-compliance with documentation standards., Financial: Potential claim denials.
Mitigation Strategy
Use echocardiogram metrics to document severity., Train staff on documentation standards.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use I36.1 for nonrheumatic cases, ensuring documentation supports the etiology.
Impact
Coding tricuspid insufficiency without specifying etiology can lead to audits.
Mitigation Strategy
Ensure thorough documentation of etiology and related findings.
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 Tricuspid Insufficiency, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Tricuspid Insufficiency
Use these documentation templates to ensure complete and accurate documentation for Tricuspid Insufficiency. These templates include all required elements for proper coding and billing.
Rheumatic tricuspid insufficiency diagnosis
Specialty: CardiologyRequired Elements
- History of rheumatic fever
- Echocardiogram findings
- Severity of regurgitation
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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