ICD-10 Coding for Mitral Insufficiency(I34.0, I05.1, Q23.3)
Complete ICD-10-CM coding and documentation guide for Mitral Insufficiency. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Mitral Insufficiency
I34-I35Primary Range
Nonrheumatic mitral and aortic valve disorders
This range includes nonrheumatic mitral insufficiency, the primary focus for coding mitral valve disorders without rheumatic etiology.
Rheumatic heart diseases
This range includes rheumatic mitral insufficiency, which is relevant if the condition is specified as rheumatic.
Congenital malformations of aortic and mitral valves
This range is used if the mitral insufficiency is congenital in origin.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| I34.0 | Nonrheumatic mitral (valve) insufficiency | Use when mitral insufficiency is documented without rheumatic or congenital etiology. |
|
| I05.1 | Rheumatic mitral insufficiency | Use when mitral insufficiency is documented with rheumatic etiology. |
|
| Q23.3 | Congenital mitral insufficiency | Use when mitral insufficiency is due to congenital malformation. |
|
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 mitral insufficiency
Essential facts and insights about Mitral Insufficiency
Primary ICD-10-CM Codes for mitral insufficiency
Decision Criteria
clinical Criteria
- Echocardiogram confirms mitral regurgitation without rheumatic features.
documentation Criteria
- Documentation specifies 'nonrheumatic' or lacks rheumatic indicators.
Applicable To
- Mitral regurgitation
- Mitral valve insufficiency
Clinical Validation Requirements
- Echocardiogram showing mitral valve regurgitation
- Absence of rheumatic features
Code-Specific Risks
- Incorrectly assuming nonrheumatic when etiology is unspecified.
Coding Notes
- Ensure documentation specifies nonrheumatic etiology to avoid defaulting to rheumatic codes.
I05.1 - Rheumatic mitral insufficiency
Use when mitral insufficiency is documented with rheumatic etiology.
Applicable To
- Rheumatic mitral regurgitation
Excludes
- Nonrheumatic mitral insufficiency (I34.0)
- Congenital mitral insufficiency (Q23.3)
Clinical Validation Requirements
- History of rheumatic fever
- Echocardiogram showing rheumatic features
Coding Notes
Ensure rheumatic etiology is clearly documented to justify this code.
Q23.3 - Congenital mitral insufficiency
Use when mitral insufficiency is due to congenital malformation.
Applicable To
- Congenital mitral regurgitation
Excludes
- Nonrheumatic mitral insufficiency (I34.0)
- Rheumatic mitral insufficiency (I05.1)
Clinical Validation Requirements
- Congenital heart defect identified
- Echocardiogram confirming congenital anomaly
Coding Notes
Confirm congenital origin through diagnostic imaging or 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 Mitral Insufficiency to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code I34.0.
Impact
Clinical: May lead to inappropriate treatment decisions., Regulatory: Non-compliance with coding standards., Financial: Potential for incorrect billing and reimbursement.
Mitigation Strategy
Train staff on importance of detailed documentation., Use templates that prompt for etiology.
Impact
Reimbursement: Incorrect coding may lead to improper DRG assignment., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Query for clarification if etiology is not specified.
Impact
Lack of clear etiology can lead to audit flags.
Mitigation Strategy
Ensure all documentation includes etiology details.
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 Mitral Insufficiency, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Mitral Insufficiency
Use these documentation templates to ensure complete and accurate documentation for Mitral Insufficiency. These templates include all required elements for proper coding and billing.
Nonrheumatic mitral insufficiency diagnosis
Specialty: CardiologyRequired Elements
- Patient history
- Echocardiogram results
- Etiology specification
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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