ICD-10 Coding for Regurgitation(I34.0, I07.1)
Complete ICD-10-CM coding and documentation guide for Regurgitation. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Regurgitation
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 echocardiogram confirms nonrheumatic mitral regurgitation. |
|
| I07.1 | Rheumatic tricuspid insufficiency | Use when rheumatic history and imaging confirm tricuspid regurgitation. |
|
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 nonrheumatic mitral regurgitation
Essential facts and insights about Regurgitation
Primary ICD-10-CM Codes for regurgitation
Decision Criteria
clinical Criteria
- Echocardiogram findings consistent with nonrheumatic etiology.
Applicable To
- Degenerative mitral valve regurgitation
Clinical Validation Requirements
- Echocardiogram showing >30% regurgitant fraction
- Absence of rheumatic history
Code-Specific Risks
- Misclassification as rheumatic without proper documentation
Coding Notes
- Ensure documentation specifies nonrheumatic etiology.
I07.1 - Rheumatic tricuspid insufficiency
Use when rheumatic history and imaging confirm tricuspid regurgitation.
Applicable To
- Rheumatic tricuspid valve regurgitation
Excludes
- Nonrheumatic tricuspid valve disorders (I36.0-I36.9)
Clinical Validation Requirements
- History of rheumatic fever
- Valve thickening on imaging
Coding Notes
Ensure rheumatic history is documented.
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 Regurgitation to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code I34.0.
Impact
Clinical: Inadequate assessment of severity and treatment needs., Regulatory: Non-compliance with coding guidelines., Financial: Potential for denied claims due to insufficient documentation.
Mitigation Strategy
Ensure echocardiogram reports are included in the patient's file., Train staff on the importance of detailed imaging documentation.
Impact
Reimbursement: Potential for incorrect DRG assignment., Compliance: Risk of audit failure due to incorrect coding., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Query for clarification if rheumatic history is not documented.
Impact
Inadequate documentation of etiology leading to incorrect coding.
Mitigation Strategy
Implement mandatory query protocols for unclear 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 Regurgitation, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Regurgitation
Use these documentation templates to ensure complete and accurate documentation for Regurgitation. These templates include all required elements for proper coding and billing.
Mitral Regurgitation Documentation
Specialty: CardiologyRequired Elements
- Etiology
- Severity
- Echocardiogram findings
- Associated conditions
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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