ICD-10 Coding for Aortic Insufficiency(I35.1, I06.1)
Complete ICD-10-CM coding and documentation guide for Aortic Insufficiency. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Aortic 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 |
|---|---|---|---|
| I35.1 | Nonrheumatic aortic (valve) insufficiency | Use when aortic insufficiency is confirmed as nonrheumatic and documented with echocardiographic evidence. |
|
| I06.1 | Rheumatic aortic insufficiency | Use when aortic insufficiency is confirmed as rheumatic with documented history or clinical evidence. |
|
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 aortic insufficiency
Essential facts and insights about Aortic Insufficiency
Primary ICD-10-CM Codes for aortic insufficiency
Decision Criteria
clinical Criteria
- Echocardiogram confirms nonrheumatic aortic insufficiency
documentation Criteria
- Nonrheumatic etiology explicitly stated
Applicable To
- Nonrheumatic aortic regurgitation
Excludes
- Rheumatic aortic insufficiency (I06.1)
Clinical Validation Requirements
- Echocardiogram showing regurgitant volume or vena contracta
- Clinical symptoms such as dyspnea or heart failure
Code-Specific Risks
- Incorrectly coding as rheumatic without proper documentation
Coding Notes
- Ensure documentation specifies nonrheumatic etiology and includes echocardiographic findings.
I06.1 - Rheumatic aortic insufficiency
Use when aortic insufficiency is confirmed as rheumatic with documented history or clinical evidence.
Applicable To
- Rheumatic aortic regurgitation
Excludes
- Nonrheumatic aortic insufficiency (I35.1)
Clinical Validation Requirements
- History of rheumatic fever
- Echocardiogram findings consistent with rheumatic changes
Coding Notes
Ensure rheumatic etiology is documented and supported by clinical history.
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 Aortic Insufficiency to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code I35.1.
Impact
Clinical: Inadequate treatment planning due to lack of severity information., Regulatory: Non-compliance with coding guidelines requiring severity documentation., Financial: Potential loss of reimbursement for undercoded severity.
Mitigation Strategy
Ensure echocardiogram reports include severity metrics., Train providers on the importance of documenting severity.
Impact
Reimbursement: Incorrect coding can lead to improper DRG assignment and affect reimbursement., Compliance: May result in non-compliance with coding guidelines., Data Quality: Affects the accuracy of clinical data and patient records.
Mitigation Strategy
Query the provider for clarification on whether the condition is rheumatic or nonrheumatic.
Impact
Risk of audits due to unspecified etiology in aortic insufficiency cases.
Mitigation Strategy
Implement provider education on the importance of specifying etiology.
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 Aortic Insufficiency, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Aortic Insufficiency
Use these documentation templates to ensure complete and accurate documentation for Aortic Insufficiency. These templates include all required elements for proper coding and billing.
Nonrheumatic Aortic Insufficiency
Specialty: CardiologyRequired Elements
- Patient symptoms
- Echocardiogram findings
- Etiology (nonrheumatic)
- Severity of insufficiency
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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