ICD-10 Coding for Valve Disease(I05.0, I35.0)
Complete ICD-10-CM coding and documentation guide for Valve Disease. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Valve Disease
I05-I08Primary Range
Rheumatic heart diseases
Covers rheumatic conditions affecting heart valves, including mitral and aortic stenosis.
Nonrheumatic valve disorders
Includes nonrheumatic conditions such as mitral valve prolapse and aortic stenosis.
Congenital malformations of cardiac septa and valves
Covers congenital anomalies like bicuspid aortic valve.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| I05.0 | Rheumatic mitral stenosis | Use when mitral stenosis is confirmed to be rheumatic in origin. |
|
| I35.0 | Nonrheumatic aortic stenosis | Use for aortic stenosis not related 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 rheumatic mitral stenosis
Essential facts and insights about Valve Disease
Primary ICD-10-CM Codes for valve disease
Decision Criteria
clinical Criteria
- Confirmed history of rheumatic fever and echocardiographic evidence.
Applicable To
- Mitral stenosis due to rheumatic fever
Excludes
- Nonrheumatic mitral stenosis
Clinical Validation Requirements
- History of rheumatic fever
- TTE showing mitral valve area ≤1.5 cm²
Code-Specific Risks
- Misclassification if rheumatic etiology is not documented.
Coding Notes
- Ensure documentation specifies rheumatic origin.
I35.0 - Nonrheumatic aortic stenosis
Use for aortic stenosis not related to rheumatic fever.
Applicable To
- Calcific aortic stenosis
Excludes
- Rheumatic aortic stenosis
Clinical Validation Requirements
- TTE showing aortic valve area ≤1.0 cm²
- Mean gradient ≥40 mmHg
Coding Notes
Document calcific or degenerative changes 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 Valve Disease to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code I05.0.
Impact
Clinical: Leads to inadequate treatment planning., Regulatory: Increases risk of audit issues., Financial: May result in denied claims.
Mitigation Strategy
Ensure detailed documentation of valve condition., Use specific codes whenever possible.
Impact
Reimbursement: Incorrect DRG assignment leading to reimbursement issues., Compliance: Potential for audit discrepancies., Data Quality: Inaccurate clinical data affecting patient care.
Mitigation Strategy
Ensure clear documentation of etiology and history of rheumatic fever.
Impact
Use of unspecified codes can trigger audits.
Mitigation Strategy
Ensure comprehensive documentation of valve disease specifics.
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 Valve Disease, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Valve Disease
Use these documentation templates to ensure complete and accurate documentation for Valve Disease. These templates include all required elements for proper coding and billing.
Rheumatic mitral stenosis with heart failure
Specialty: CardiologyRequired Elements
- Patient history of rheumatic fever
- TTE findings
- Heart failure symptoms
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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