ICD-10 Coding for Aortic Valve Insufficiency(I35.1, I06.1, Q23.83)
Complete ICD-10-CM coding and documentation guide for Aortic Valve Insufficiency. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Aortic Valve Insufficiency
I35-I38Primary Range
Nonrheumatic Aortic Valve Disorders
This range includes codes for nonrheumatic aortic valve insufficiency, which is the primary focus for coding this condition.
Rheumatic Heart Diseases
This range includes codes for rheumatic aortic valve insufficiency, applicable when the condition is due to rheumatic fever.
Congenital Malformations of Circulatory System
This range includes codes for congenital aortic valve conditions, such as bicuspid aortic valve, which may require additional coding.
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 nonrheumatic and confirmed by echocardiographic criteria. |
|
| I06.1 | Rheumatic aortic insufficiency | Use when aortic insufficiency is due to rheumatic fever. |
|
| Q23.83 | Congenital bicuspid aortic valve | Use when a congenital bicuspid aortic valve is documented. |
|
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 valve insufficiency
Essential facts and insights about Aortic Valve Insufficiency
Primary ICD-10-CM Codes for aortic valve insufficiency
Decision Criteria
clinical Criteria
- Nonrheumatic etiology confirmed by echocardiography
documentation Criteria
- Severity documented with quantitative measures
Applicable To
- Nonrheumatic aortic regurgitation
Excludes
- Rheumatic aortic insufficiency (I06.1)
Clinical Validation Requirements
- Echocardiographic evidence of regurgitant volume ≥60 mL/beat
- Vena contracta width ≥0.6 cm
Code-Specific Risks
- Incorrectly coding as rheumatic without evidence
- Missing documentation of severity
Coding Notes
- Ensure documentation specifies nonrheumatic etiology and includes quantitative severity measures.
I06.1 - Rheumatic aortic insufficiency
Use when aortic insufficiency is due to rheumatic fever.
Applicable To
- Aortic insufficiency due to rheumatic fever
Excludes
- Nonrheumatic aortic insufficiency (I35.1)
Clinical Validation Requirements
- History of rheumatic fever
- Echocardiographic evidence consistent with rheumatic changes
Coding Notes
Documentation must explicitly link aortic insufficiency to rheumatic fever.
Q23.83 - Congenital bicuspid aortic valve
Use when a congenital bicuspid aortic valve is documented.
Applicable To
- Bicuspid aortic valve
Clinical Validation Requirements
- Echocardiographic confirmation of bicuspid valve anatomy
Coding Notes
Always code congenital anomaly when documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Heart failure
I50.-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 Valve 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., Regulatory: Non-compliance with coding standards., Financial: Potential reimbursement issues.
Mitigation Strategy
Use structured templates, Include quantitative metrics
Impact
Reimbursement: Incorrect DRG assignment may affect reimbursement., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Verify etiology through patient history and documentation.
Impact
Reimbursement: Potential under-coding affecting reimbursement., Compliance: Failure to capture complete clinical picture., Data Quality: Incomplete patient records.
Mitigation Strategy
Ensure congenital conditions are coded when documented.
Impact
Inadequate documentation of AR etiology.
Mitigation Strategy
Ensure detailed history and echocardiographic findings are documented.
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 Valve Insufficiency, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Aortic Valve Insufficiency
Use these documentation templates to ensure complete and accurate documentation for Aortic Valve Insufficiency. These templates include all required elements for proper coding and billing.
Aortic Valve Insufficiency Assessment
Specialty: CardiologyRequired Elements
- Etiology
- Severity
- Quantitative criteria
- Associated conditions
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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