ICD 10 Coding Alert

Question: How should you report nonrheumatic mitral valve insufficiency?

Connecticut Subscriber

Answer: For this ICD-10 code, you should go to category I34- (Nonrheumatic mitral valve disorders) and then choose I34.0 (Nonrheumatic mitral (valve) insufficiency).

Don't miss:  Included conditions for I34.0 are nonrheumatic mitral (valve) incompetence NOS and nonrheumatic mitral (valve) regurgitation NOS and if the cause is not mentioned.

Caution: Make sure you look in the documentation to see that the physician specified that the patient's condition is nonrheumatic because this will impact your coding choice.

According to an Includes note in ICD-10, the I05- (Rheumatic mitral valve diseases) range is appropriate "for conditions classifiable to both I05.0 (Rheumatic mitral stenosis) and I05.2 (Rheumatic mitral stenosis with insufficiency) through I05.9 (Rheumatic mitral valve disease, unspecified), whether specified as rheumatic or not."

Takeaway: If the documentation specifically states that the mitral valve insufficiency is rheumatic, you would choose I05.2. However, if the physician states that the mitral valve insufficiency is not rheumatic or if the cause isn't mentioned, you would choose I34.0.

"ICD-10-CM presumes that certain valve disorders of unspecified etiology are rheumatic in origin," says Christina Neighbors, MA, CPC, CCC, Coding Quality Auditor for Conifer Health Solutions, Coding Quality & Education Department, and member of AAPC's Certified Cardiology Coder steering committee. "When the diagnostic statement includes more than one condition (i.e. mitral stenosis and insufficiency) affecting a single valve or multiple valves, one of which is presumed to be rheumatic, all are classified as rheumatic."

Be careful: The rules change when a patient has multiple valve disease specified as rheumatic or unspecified. You would refer to I08.0 (Rheumatic disorders of both mitral and aortic valves) through I08.9 (Rheumatic multiple valve disease, unspecified), Neighbors adds.