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Z95.2
ICD-10-CM
Valve Replacement

Find comprehensive information on valve replacement diagnosis, including aortic valve replacement, mitral valve replacement, TAVR, TMVR, valve repair, and prosthetic valve endocarditis. This resource covers clinical documentation requirements, ICD-10 codes (Z95.1, Z95.2, and related codes), medical coding guidelines, and postoperative care for healthcare professionals. Learn about the diagnostic process, treatment options, and long-term management of valve disease requiring valve replacement.

Also known as

Heart Valve Surgery
Cardiac Valve Replacement

Diagnosis Snapshot

Key Facts
  • Definition : Surgical replacement of a diseased heart valve with a mechanical or tissue valve.
  • Clinical Signs : Murmur, shortness of breath, chest pain, dizziness, fatigue, swollen ankles or feet.
  • Common Settings : Hospital operating room, cardiac catheterization lab (for TAVR).

Related ICD-10 Code Ranges

Complete code families applicable to AAPC Z95.2 Coding
02RF-02RX

Replacement of heart valve

Codes for replacing a heart valve with a prosthetic valve.

Z95.0-Z95.9

Presence of cardiac and vascular implants

Indicates presence of implanted devices, including heart valves.

I34-I39

Nonrheumatic valvular diseases

Covers conditions often leading to valve replacement.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the valve replacement biological?

  • Yes

    Which valve?

  • No

    Is it mechanical?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Valve Replacement
Valve Repair
Transcatheter Aortic Valve Replacement (TAVR)

Documentation Best Practices

Documentation Checklist
  • Valve replaced (e.g., aortic, mitral, tricuspid, pulmonic)
  • Type of valve replacement (mechanical, tissue, bioprosthetic)
  • Pre-op indications for valve replacement (stenosis, regurgitation)
  • Intraoperative details, including size of valve
  • Postoperative assessment of valve function

Coding and Audit Risks

Common Risks
  • Device Specificity

    Lack of documentation specifying the type of valve (mechanical, tissue, transcatheter) impacting code selection and reimbursement.

  • Procedure Coding

    Incorrect coding for the approach (open, minimally invasive) or additional procedures like root replacement leading to claim denials.

  • Comorbidity Capture

    Insufficient documentation of coexisting conditions affecting patient severity and accurate DRG assignment for appropriate reimbursement.

Mitigation Tips

Best Practices
  • Accurate valve type/location in clinical documentation improves coding.
  • Thorough pre-op notes justify medical necessity for valve replacement.
  • Specific intra-op details support correct DRG assignment, prevent denials.
  • Post-op complications documented precisely impact reimbursement, quality metrics.
  • Timely physician queries clarify ambiguous documentation for accurate coding.

Clinical Decision Support

Checklist
  • Confirm valve dysfunction (e.g., stenosis, regurgitation) documented
  • Verify LVEF assessment & NYHA class documented if applicable
  • Check documentation supports surgical/TAVR decision
  • Ensure appropriate pre-op imaging/testing results present
  • Confirm informed consent obtained and documented

Reimbursement and Quality Metrics

Impact Summary
  • Valve Replacement reimbursement hinges on accurate coding (ICD-10-PCS, CPT) impacting DRG assignment and hospital payments.
  • Coding quality directly affects Case Mix Index (CMI), influencing hospital reimbursement and public quality reporting.
  • Thorough documentation of valve type, approach, and complications is crucial for appropriate reimbursement and accurate quality metrics.
  • Timely and accurate claims submission minimizes denials and optimizes revenue cycle management for valve replacement procedures.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes for . Our AI-powered assistant ensures compliance and reduces coding errors.

Quick Tips

Practical Coding Tips
  • Code specific valve replaced
  • Document valve type/material
  • ICD-10-PCS approach code
  • Capture size/model if applicable
  • Check clinical indicators for cause

Documentation Templates

Patient presents for evaluation and management of symptomatic valvular heart disease requiring valve replacement surgery.  Presenting symptoms include [Specific symptoms e.g., dyspnea, chest pain, syncope, fatigue], impacting the patient's functional capacity and quality of life.  Physical examination reveals [Specific findings e.g., murmur, edema, jugular venous distension].  Diagnostic workup including echocardiography demonstrates [Specific echocardiographic findings e.g., severe aortic stenosis, mitral regurgitation] confirming the need for valve replacement.  The patient's medical history includes [Relevant comorbidities e.g., hypertension, diabetes, coronary artery disease] and previous cardiac interventions [List prior interventions if any].  Risks and benefits of surgical valve replacement including bioprosthetic valve vs. mechanical valve options were thoroughly discussed with the patient.  The patient understands the need for lifelong anticoagulation therapy if a mechanical valve is selected.  Aortic valve replacement, mitral valve replacement, transcatheter aortic valve replacement (TAVR), and minimally invasive valve surgery were considered.  After careful consideration of the patient's clinical presentation, comorbidities, and preferences, a treatment plan for [Specific valve replacement procedure e.g., surgical aortic valve replacement with a bioprosthetic valve] was developed.  The patient was deemed a suitable candidate for surgery and scheduled for the procedure.  Postoperative care will include cardiac rehabilitation and close monitoring for complications such as bleeding, infection, and thromboembolism.  Patient education regarding medication management, follow-up appointments, and lifestyle modifications was provided.
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