ICD-10 Coding for Tricuspid Valve Regurgitation(I07.1, I36.1, Q22.8)
Complete ICD-10-CM coding and documentation guide for Tricuspid Valve Regurgitation. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Tricuspid Valve 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 valve insufficiency | Use for nonrheumatic causes of tricuspid regurgitation. |
|
| Q22.8 | Other congenital malformations of tricuspid valve | Use for congenital anomalies of the tricuspid valve. |
|
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 valve regurgitation
Essential facts and insights about Tricuspid Valve Regurgitation
Primary ICD-10-CM Codes for tricuspid valve regurgitation
Decision Criteria
clinical Criteria
- Confirmed history of rheumatic fever
Applicable To
- Rheumatic tricuspid valve regurgitation
Excludes
- Nonrheumatic tricuspid valve disorders (I36.-)
Clinical Validation Requirements
- History of rheumatic fever
- Echo findings of commissural fusion
Code-Specific Risks
- Misclassification if rheumatic etiology is not confirmed
Coding Notes
- Ensure rheumatic etiology is documented.
I36.1 - Nonrheumatic tricuspid valve insufficiency
Use for nonrheumatic causes of tricuspid regurgitation.
Applicable To
- Functional tricuspid regurgitation
Excludes
- Rheumatic tricuspid valve disorders (I07.-)
Clinical Validation Requirements
- Echo findings of annular dilation
- Regurgitant volume ≥45ml
Coding Notes
Document severity and etiology clearly.
Q22.8 - Other congenital malformations of tricuspid valve
Use for congenital anomalies of the tricuspid valve.
Applicable To
- Ebstein’s anomaly
Excludes
- Non-congenital tricuspid valve disorders
Clinical Validation Requirements
- Pediatric echo report confirming congenital anomaly
Coding Notes
Ensure congenital nature is documented.
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 Tricuspid Valve 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 clinical picture, Regulatory: Non-compliance with coding guidelines, Financial: Potential reimbursement loss
Mitigation Strategy
Review patient history for underlying conditions, Include all relevant clinical findings
Impact
Reimbursement: May lead to lower DRG assignment, Compliance: Non-compliance with specificity requirements, Data Quality: Reduces accuracy of clinical data
Mitigation Strategy
Query for specific etiology and severity
Impact
Use of unspecified codes like I36.9 can trigger audits.
Mitigation Strategy
Ensure documentation specifies etiology and severity.
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 Valve Regurgitation, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Tricuspid Valve Regurgitation
Use these documentation templates to ensure complete and accurate documentation for Tricuspid Valve Regurgitation. These templates include all required elements for proper coding and billing.
Nonrheumatic TR with pulmonary hypertension
Specialty: CardiologyRequired Elements
- Echo findings
- Symptoms
- Underlying conditions
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Tricuspid Valve Regurgitation? Ask your questions below.