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I38
ICD-10-CM
Valvular Heart Disease

Find comprehensive information on valvular heart disease, including aortic stenosis, mitral regurgitation, tricuspid valve disease, and pulmonary valve disorders. This resource covers clinical documentation requirements, ICD-10 codes (I34, I35, I36, I37, I38, I39), medical coding guidelines, and healthcare best practices for diagnosing and managing valvular heart conditions. Learn about symptoms, echocardiogram interpretation, treatment options, and the impact of valvular heart disease on cardiovascular health.

Also known as

Heart Valve Disease
Valvular Disease
valvular disorder

Diagnosis Snapshot

Key Facts
  • Definition : Heart valve dysfunction disrupting normal blood flow.
  • Clinical Signs : Shortness of breath, chest pain, dizziness, fatigue, murmur.
  • Common Settings : Cardiology clinic, hospital, cardiac surgery centers.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC I38 Coding
I05-I09

Chronic rheumatic heart diseases

Heart conditions caused by rheumatic fever.

I33-I39

Other forms of heart disease

Includes various non-rheumatic valvular disorders.

I06

Rheumatic mitral valve diseases

Mitral valve problems due to rheumatic fever.

I07

Rheumatic tricuspid valve diseases

Tricuspid valve problems due to rheumatic fever.

Code-Specific Guidance

Decision Tree for

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

Which valve is affected?

  • Aortic

    Stenosis or regurgitation?

  • Mitral

    Stenosis or regurgitation?

  • Tricuspid

    Stenosis or regurgitation?

  • Pulmonary

    Stenosis or regurgitation?

  • Multiple valves

    Code I08 (Multiple valve diseases). Specify valves affected.

Code Comparison

Related Codes Comparison

When to use each related code

Description
Valvular heart disease
Mitral valve prolapse
Aortic stenosis

Documentation Best Practices

Documentation Checklist
  • Valvular heart disease diagnosis documentation:
  • Specific valve(s) affected (e.g., mitral, aortic)
  • Severity (mild, moderate, severe)
  • Etiology (rheumatic, congenital, degenerative)
  • Symptoms (dyspnea, chest pain, syncope)
  • Relevant diagnostic tests (ECG, echo, catheterization)

Coding and Audit Risks

Common Risks
  • Unspecified Valve

    Coding VHD without specifying the affected valve (aortic, mitral, etc.) leads to inaccurate severity and treatment reflection.

  • Severity Mismatch

    Documentation lacking clear severity (mild, moderate, severe) for VHD impacts accurate coding and reimbursement.

  • Etiology Omission

    Failing to document the underlying cause (rheumatic, congenital, etc.) of VHD hinders accurate coding and statistical analysis.

Mitigation Tips

Best Practices
  • Accurate echo reports with valve details for ICD-10 coding (I34, I05-I09)
  • Thorough history and physical exam for VHD subtype diagnosis and CDI
  • Consistent documentation of symptoms, severity, and etiology for HCC compliance
  • Regular follow-up and medication adherence monitoring for optimal patient outcomes
  • Timely intervention, including surgical options, documented for improved quality metrics

Clinical Decision Support

Checklist
  • Auscultate for murmurs ICD10 I34 I05 I06 I07 I08
  • Echocardiogram report review ICD10 I34 I05 I06 I07 I08
  • Assess symptoms dyspnea chest pain syncope ICD10 I50 R07 I49
  • Review patient history for rheumatic fever ICD10 I00

Reimbursement and Quality Metrics

Impact Summary
  • Valvular Heart Disease Reimbursement: Coding accuracy impacts MS-DRG assignment (e.g., 216, 217, 220) affecting hospital payments.
  • Quality Metrics Impact: VHD treatment adherence (medication, follow-up) affects Leapfrog Hospital Safety Grade.
  • Coding: Accurate ICD-10-CM (e.g., I05-I09, I33-I39) and PCS coding crucial for appropriate reimbursement.
  • Reporting: Proper documentation of VHD severity and comorbidities influences publicly reported hospital outcomes.

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, stenosis/regurgitation
  • Document etiology, acuity, laterality
  • Echo report crucial for accurate coding
  • Use combination codes when applicable
  • Consider sequelae, like heart failure

Documentation Templates

Valvular heart disease assessment reveals [Specify valve involved: aortic, mitral, tricuspid, pulmonary] valve [Specify dysfunction: stenosis, regurgitation, prolapse, atresia]. Patient presents with [List presenting symptoms: dyspnea, chest pain, palpitations, syncope, edema, fatigue].  Physical examination findings include [Document relevant findings: murmur, abnormal heart sounds, jugular venous distention, crackles].  Echocardiogram confirms [Specify echocardiographic findings: valve morphology, chamber size, ejection fraction, degree of stenosis or regurgitation].  Severity of valvular heart disease is classified as [Specify severity: mild, moderate, severe].  Differential diagnosis includes [List relevant differentials: coronary artery disease, cardiomyopathy, pericarditis].  Assessment indicates [Specify: symptomatic vs. asymptomatic, compensated vs. decompensated heart failure].  Treatment plan includes [Specify medical management: diuretics, ACE inhibitors, beta blockers, anticoagulants. Specify interventions: valvuloplasty, valve replacement, surgical repair. Specify monitoring: echocardiography, EKG, exercise stress test].  Patient education provided on medication management, lifestyle modifications (sodium restriction, fluid restriction), and follow-up care.  ICD-10 code [Specify appropriate ICD-10 code based on valve involved and dysfunction, e.g., I05.0, I06.0, I07.1, I08.0].  Medical billing codes for diagnostic tests and procedures performed are documented.  Prognosis discussed with the patient, including potential complications and the importance of adherence to the treatment plan. Follow-up scheduled for [Specify timeframe].
Valvular Heart Disease - AI-Powered ICD-10 Documentation