Valvular Heart Disease ICD-10-CM Codes

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What ICD-10 codes are used for valvular heart disease?Which valvular heart disease ICD codes are billable?Clinical information Synonyms include FAQS

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What ICD-10 codes are used for valvular heart disease?

Valvular heart disease is a condition characterized by dysfunction or abnormalities in one or more heart valves. Proper coding is crucial for accurate medical documentation and billing. Below are six commonly used ICD-10-CM codes for various types of valvular heart disease and their comprehensive clinical descriptions.

I05.0: Rheumatic mitral stenosis

Narrowing of the mitral valve orifice due to rheumatic fever and subsequent scarring reduces blood flow from the left atrium to the left ventricle.

I05.8: Other rheumatic mitral valve diseases

Encompasses various rheumatic conditions affecting the mitral valve, such as regurgitation and prolapse, caused by rheumatic fever-induced damage.

I34.0: Nonrheumatic mitral (valve) insufficiency

Refers to the incompetence of the mitral valve due to causes other than rheumatic, leading to backflow of blood from the left ventricle to the left atrium.

I35.0: Nonrheumatic aortic (valve) stenosis

Narrowing of the aortic valve orifice, which impedes blood flow from the left ventricle to the aorta, is caused by factors other than rheumatic fever.

I35.8: Other nonrheumatic aortic valve disorders

Covers various nonrheumatic conditions affecting the aortic valve, including aortic valve regurgitation and bicuspid aortic valve anomalies.

I37.0: Nonrheumatic pulmonary valve stenosis

The pulmonary valve becomes narrowed due to causes unrelated to rheumatic fever, obstructing blood flow from the right ventricle to the pulmonary artery.

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Which valvular heart disease ICD codes are billable?

The following ICD-10-CM codes for valvular heart disease are billable:

I05.0–Rheumatic mitral stenosis: This code is billable, as it specifies a rheumatic cause for mitral stenosis, and rheumatic heart disease is reimbursable.
I05.8–Other rheumatic mitral valve diseases: This code covers various rheumatic mitral valve disorders, all of which are considered billable conditions.
I34.0–Nonrheumatic mitral (valve) insufficiency: Nonrheumatic mitral insufficiency is billable, as it refers to mitral valve regurgitation caused by factors other than rheumatic fever.
I35.0–Nonrheumatic aortic (valve) stenosis: Nonrheumatic aortic stenosis is billable, encompassing various causes of aortic valve narrowing unrelated to rheumatic fever.
I35.8–Other nonrheumatic aortic valve disorders: This code covers different nonrheumatic aortic valve conditions, which are billable for proper reimbursement.
I37.0–Nonrheumatic pulmonary valve stenosis: Nonrheumatic pulmonary valve stenosis is billable, indicating pulmonary valve narrowing is not caused by rheumatic factors.

Clinical information

Valvular heart disease encompasses conditions affecting the heart valve, impairing its normal functioning.
Valvular disorders, such as stenosis (narrowing) or insufficiency (leakage), can be caused by rheumatic diseases or nonrheumatic factors.
Common types include aortic stenosis, aortic regurgitation, mitral stenosis, and mitral regurgitation.
These conditions can be congenital malformations or acquired due to age-related degeneration, infections (e.g., endocarditis), or rheumatic fever.
Rheumatic aortic stenosis results from rheumatic fever that damages the aortic valve.
Stenosis with insufficiency can occur when a valve is both narrowed and leaking.
Tricuspid valve diseases affect the valve between the right atrium and right ventricle.
Conditions may be classified as specified as rheumatic when there is evidence of rheumatic fever history.
Congenital stenosis and congenital insufficiency are present from birth due to developmental abnormalities.
Several valve conditions may be categorized as diseases classified elsewhere or valve disorders in diseases classified in other sections of ICD-10.
When the specific valve is not documented, the code for cardiac valve NOS or not otherwise specified is used.
Valve disease unspecified codes apply when the exact nature of the valve disorder is not documented.
Proper treatment and adherence to medical advice improve symptoms, quality of life, and long-term outcomes. Preventive measures include managing risk factors and promptly treating infections to reduce the risk of developing valvular heart disease.

Synonyms include

Valvular heart disorder
Heart valve disease
Cardiac valve dysfunction
Valvular heart condition
Cardiac valve disorder
Rheumatic aortic valve disease
Rheumatic multiple valve disease
Nonrheumatic tricuspid valve disorder
Endocarditis, valve unspecified

Commonly asked questions

Can valvular heart disease be present at birth?

Yes, valvular heart disease can be present at birth as a form of congenital heart disease. Congenital heart defects are the most common type of congenital disability. Many patients have primary congenital valvular lesions, such as a bicuspid aortic valve (BAV). Other examples include congenital pulmonic stenosis, Ebstein's anomaly affecting the tricuspid valve, and various mitral valve abnormalities like cleft or parachute mitral valve.

Are all valvular heart diseases caused by rheumatic fever?

No, not all valvular heart diseases are caused by rheumatic fever. While rheumatic fever is a significant cause of valvular heart disease, particularly in developing countries, there are many other etiologies. Congenital defects can cause valvular abnormalities present from birth.

Can valvular heart disease be managed with medications alone?

In some cases, valvular heart disease can be managed with medications alone, but this depends on the specific type and severity of the valve disorder. Management often involves a collaborative effort between general cardiologists and congenital heart disease specialists to determine the most appropriate treatment plan, which may include medications, surveillance with imaging studies, and, in some cases, surgical or interventional procedures.