ICD-10 Coding for Mitral Valve Disorder(I05.0, I34.0)
Complete ICD-10-CM coding and documentation guide for Mitral Valve Disorder. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Mitral Valve Disorder
I05.0-I05.9Primary Range
Rheumatic mitral valve disorders
Covers mitral valve disorders due to rheumatic fever, including stenosis and insufficiency.
Nonrheumatic mitral valve disorders
Includes nonrheumatic conditions like mitral insufficiency and prolapse.
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 documentation specifies rheumatic etiology with stenosis. |
|
| I34.0 | Nonrheumatic mitral insufficiency | Use for nonrheumatic mitral valve insufficiency confirmed by echo. |
|
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 valve disorder
Essential facts and insights about Mitral Valve Disorder
Primary ICD-10-CM Codes for mitral valve disorder
Decision Criteria
clinical Criteria
- Presence of rheumatic stigmata and stenosis on echo.
Applicable To
- Rheumatic mitral stenosis
Excludes
- Nonrheumatic mitral stenosis (I34.2)
Clinical Validation Requirements
- Echo: Valve area ≤1.5 cm², commissural fusion, rheumatic stigmata
Code-Specific Risks
- Assuming rheumatic etiology without documentation.
Coding Notes
- Ensure documentation specifies rheumatic origin.
I34.0 - Nonrheumatic mitral insufficiency
Use for nonrheumatic mitral valve insufficiency confirmed by echo.
Applicable To
- Degenerative mitral insufficiency
Excludes
- Rheumatic mitral insufficiency (I05.1)
Clinical Validation Requirements
- Echo: Regurgitant volume ≥60 mL/beat, vena contracta ≥0.7 cm
Coding Notes
Document specific echo findings.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Mitral Valve Disorder 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 incorrect treatment plans., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Always document etiology., Use templates to ensure completeness.
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Query provider for clarification on etiology.
Impact
Lack of specific etiology can lead to audit flags.
Mitigation Strategy
Ensure all documentation specifies rheumatic or nonrheumatic origin.
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 Valve Disorder, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Mitral Valve Disorder
Use these documentation templates to ensure complete and accurate documentation for Mitral Valve Disorder. These templates include all required elements for proper coding and billing.
Mitral Valve Disorder Evaluation
Specialty: CardiologyRequired Elements
- NYHA Class
- Echo findings
- Etiology
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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