Cardiology Coding Alert

Not sure whether to use the ‘insufficiency’ or ‘other’ code for incompetence NOS? Here’s the answer.

ICD-10 is ousting the simplicity of a single code for nonrheumatic mitral valve disorders. Check out the five new options you’ll need to know.

ICD-9-CM Code

424.0, Mitral valve disorders

ICD-10-CM Codes

• I34.0, Nonrheumatic mitral (valve) insufficiency
• I34.1, Nonrheumatic mitral (valve) prolapse
• I34.2, Nonrheumatic mitral (valve) stenosis
• I34.8, Other nonrheumatic mitral valve disorders
• I34.9, Nonrheumatic mitral valve disorder, unspecified

A disorder of the mitral valve refers to a problem with the valve between the heart’s two left chambers.

ICD-9 coding rules: ICD-9 offers one code for nonrheumatic mitral valve disorders. Among the notes with the code is an excludes note pointing you instead to 394.1 (Rheumatic mitral insufficiency) when documentation specifies “rheumatic.”

ICD-10 changes: You’ll need to choose from multiple nonrheumatic mitral valve disorder codes in the I34.- range under ICD-10. You’ll have separate codes for insufficiency (I34.0), prolapse (I34.1), stenosis (I34.2), other (I34.8), and unspecified (I34.9).

Be sure to apply the following rules to all codes in the I34.- range for nonrheumatic mitral valve disorders:

Excludes1:

Mitral valve disease (I05.9)
Mitral valve failure (I05.8)
Mitral valve stenosis (I05.0)
Mitral valve disorder of unspecified cause with diseases of aortic and/or tricuspid valve(s) (I08.-)
Mitral valve disorder of unspecified cause with mitral stenosis or obstruction (I05.0)
Mitral valve disorder specified as congenital (Q23.2, Q23.3)
Mitral valve disorder specified as rheumatic (I05.-).

Documentation: To support proper coding, the physician should take care to document whether the mitral valve disease is rheumatic or not rheumatic. Also alert physicians that you need to know whether the condition is congenital because it affects your code choice. Because you won’t have the one-code-fits-all option for mitral valve disorders under ICD-10, your physician’s documentation needs to specify the type of disorder (insufficiency, prolapse, stenosis) for you to choose the most specific code.

Coder tips: If the physician documents nonrheumatic mitral incompetence NOS or regurgitation NOS, you should use I34.0 rather than “other” code I34.8.

Also, before reporting I34.1, recall that it’s appropriate for floppy nonrheumatic mitral valve syndrome, but the code is not appropriate if the patient has Marfan’s syndrome (Q87.4-).

Remember: CMS has announced Oct. 1, 2015, as the new compliance date for ICD-10. When ICD-10-CM goes into effect, you should apply the code set and official guidelines in effect for the date of service reported. Learn more at www.cms.gov/ICD10/ and www.cdc.gov/nchs/icd/icd10cm.htm#10update.