ICD-10 Coding for Valve Heart Disease(I05.0, I35.0, Q23.81)
Complete ICD-10-CM coding and documentation guide for Valve Heart Disease. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Valve Heart Disease
Rheumatic heart diseases
Includes rheumatic valvular disorders, important for differentiating rheumatic from nonrheumatic conditions.
I34-I37Primary Range
Nonrheumatic valve disorders
Primary range for nonrheumatic valvular heart diseases, covering specific valve conditions.
Congenital malformations of cardiac septa and valves
Includes congenital valve disorders 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 rheumatic origin is confirmed with specific echocardiographic findings. |
|
| I35.0 | Nonrheumatic aortic stenosis | Use for nonrheumatic aortic stenosis confirmed by calcification and echocardiographic criteria. |
|
| Q23.81 | Congenital bicuspid aortic valve | Use for congenital bicuspid aortic valve confirmed by imaging. |
|
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 nonrheumatic aortic stenosis
Essential facts and insights about Valve Heart Disease
Primary ICD-10-CM Codes for valve heart disease
Decision Criteria
clinical Criteria
- Rheumatic history and echocardiographic findings
Applicable To
- Rheumatic mitral stenosis
Excludes
- Nonrheumatic mitral stenosis
Clinical Validation Requirements
- Rheumatic origin confirmed by history/ASO titers
- Echocardiogram showing mitral valve area ≤1.5 cm²
Code-Specific Risks
- Misclassification if rheumatic origin is not confirmed.
Coding Notes
- Ensure rheumatic origin is documented to avoid miscoding.
I35.0 - Nonrheumatic aortic stenosis
Use for nonrheumatic aortic stenosis confirmed by calcification and echocardiographic criteria.
Applicable To
- Calcific aortic stenosis
Excludes
- Rheumatic aortic stenosis
Clinical Validation Requirements
- Calcific aortic valve with peak gradient ≥40 mmHg on echocardiogram
Coding Notes
Document calcification and hemodynamic severity.
Q23.81 - Congenital bicuspid aortic valve
Use for congenital bicuspid aortic valve confirmed by imaging.
Applicable To
- Bicuspid aortic valve
Excludes
- Acquired aortic valve disorders
Clinical Validation Requirements
- Bicuspid aortic valve confirmed by TTE/TOE
Coding Notes
Ensure congenital nature is documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential 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 Valve Heart 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 vague clinical records., Regulatory: Non-compliance with specificity requirements., Financial: Potential for denied claims due to lack of specificity.
Mitigation Strategy
Always confirm etiology and severity with diagnostic tests., Use specific codes whenever possible.
Impact
Reimbursement: Incorrect DRG assignment may affect reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data reporting.
Mitigation Strategy
Verify etiology and use appropriate code range.
Impact
High risk of audit if unspecified codes are used without supporting documentation.
Mitigation Strategy
Ensure all valvular conditions are documented with specific etiology and severity.
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 Heart Disease, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Valve Heart Disease
Use these documentation templates to ensure complete and accurate documentation for Valve Heart Disease. These templates include all required elements for proper coding and billing.
Assessment of valvular heart disease
Specialty: CardiologyRequired Elements
- Etiology
- Severity
- Diagnostic tests
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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