ICD-10 Coding for Endocarditis(I33.0, I38)
Complete ICD-10-CM coding and documentation guide for Endocarditis. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Endocarditis
I33-I39Primary Range
Diseases of the endocardium
This range includes codes for various forms of endocarditis, including acute, subacute, and those associated with systemic diseases.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| I33.0 | Acute and subacute infective endocarditis | Use when there is confirmed acute or subacute bacterial infection of the heart valves. |
|
| I38 | Endocarditis, valve unspecified | Use when endocarditis is diagnosed but the specific valve is not identified. |
|
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 endocarditis
Essential facts and insights about Endocarditis
Primary ICD-10-CM Codes for endocarditis
Decision Criteria
clinical Criteria
- Presence of vegetation on echocardiogram and positive blood cultures.
Applicable To
- Acute bacterial endocarditis
- Subacute bacterial endocarditis
Excludes
- Endocarditis in diseases classified elsewhere (I33.1)
Clinical Validation Requirements
- Positive blood cultures
- Echocardiogram showing vegetation
Code-Specific Risks
- Misclassification if valve involvement is not specified.
Coding Notes
- Ensure documentation specifies the valve involved and the causative organism.
I38 - Endocarditis, valve unspecified
Use when endocarditis is diagnosed but the specific valve is not identified.
Excludes
- Infective endocarditis (I33.0)
Clinical Validation Requirements
- Endocarditis diagnosis without specific valve involvement.
Coding Notes
Avoid using I38 if valve involvement can be specified.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Staphylococcus aureus as the cause of diseases classified elsewhere
B95.61Differential 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 Endocarditis to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code I33.0.
Impact
Clinical: May affect treatment decisions., Regulatory: Non-compliance with coding standards., Financial: Potential for reduced reimbursement.
Mitigation Strategy
Ensure blood culture results are documented in the medical record.
Impact
Reimbursement: May lead to lower reimbursement if specific valve is not coded., Compliance: Non-compliance with coding guidelines., Data Quality: Decreased accuracy in clinical data.
Mitigation Strategy
Query the provider for specific valve involvement to use I33.0.
Impact
Risk of audits if valve involvement is not specified in endocarditis cases.
Mitigation Strategy
Ensure echocardiogram reports specify valve involvement.
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 Endocarditis, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Endocarditis
Use these documentation templates to ensure complete and accurate documentation for Endocarditis. These templates include all required elements for proper coding and billing.
Infective endocarditis with mitral valve involvement
Specialty: CardiologyRequired Elements
- Valve involvement
- Organism identification
- Complications
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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