ICD-10 Coding for Tricuspid Regurgitation(I07.1, I36.1)
Complete ICD-10-CM coding and documentation guide for Tricuspid Regurgitation. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Tricuspid 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 |
|---|---|---|---|
| I07.1 | Rheumatic tricuspid insufficiency | Use when tricuspid regurgitation is due to rheumatic heart disease. |
|
| I36.1 | Nonrheumatic tricuspid insufficiency | Use when tricuspid regurgitation is nonrheumatic. |
|
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 tricuspid regurgitation
Essential facts and insights about Tricuspid Regurgitation
Primary ICD-10-CM Codes for tricuspid regurgitation
Decision Criteria
clinical Criteria
- Confirmed rheumatic etiology with echocardiographic evidence
Applicable To
- Rheumatic tricuspid valve disease
Excludes
- Nonrheumatic tricuspid regurgitation (I36.1)
Clinical Validation Requirements
- History of rheumatic fever
- Echocardiogram showing commissural fusion or leaflet thickening
Code-Specific Risks
- Misclassification if etiology is not specified
Coding Notes
- Ensure rheumatic etiology is documented clearly.
I36.1 - Nonrheumatic tricuspid insufficiency
Use when tricuspid regurgitation is nonrheumatic.
Applicable To
- Functional tricuspid regurgitation
- Structural tricuspid regurgitation
Excludes
- Rheumatic tricuspid regurgitation (I07.1)
Clinical Validation Requirements
- Echocardiogram showing annular dilation or leaflet tethering
- Documentation of underlying cause such as pulmonary hypertension
Coding Notes
Document the primary mechanism and underlying cause.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Right heart failure
I50.31Differential 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 Tricuspid Regurgitation to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code I07.1.
Impact
Clinical: Inaccurate representation of patient's condition., Regulatory: Potential audit issues., Financial: May affect reimbursement rates.
Mitigation Strategy
Include echocardiogram measurements, Document severity in clinical notes
Impact
Reimbursement: Incorrect coding can lead to improper DRG assignment., Compliance: May result in audit discrepancies., Data Quality: Affects the accuracy of clinical data.
Mitigation Strategy
Always document whether the cause is rheumatic or nonrheumatic.
Impact
Failure to document the etiology of tricuspid regurgitation.
Mitigation Strategy
Implement mandatory fields in EHR for etiology documentation.
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 Tricuspid Regurgitation, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Tricuspid Regurgitation
Use these documentation templates to ensure complete and accurate documentation for Tricuspid Regurgitation. These templates include all required elements for proper coding and billing.
Functional TR with RV failure
Specialty: CardiologyRequired Elements
- Severity of TR
- Underlying cause
- Echocardiogram findings
- Symptoms
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Tricuspid Regurgitation? Ask your questions below.