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Question: How do I know when to report a diagnosis code for valve disease that is rheumatic in origin, versus non-rheumatic? Is rheumatic fever the only cause of mitral valve disease?

New Hampshire Subscriber

Answer: Valve diseases and disorders are categorized in ICD-10-CM according to their origin. Codes for rheumatic disorders can be found in the I05-I09 (Chronic rheumatic heart diseases) range and nonrheumatic heart disorders can be found in the I34- (Nonrheumatic mitral valve disorders). This can be confusing because I34- codes fall in the I30-I5A (Other forms of heart disease) range, which may make nonrheumatic disorders or disease seem like less specific diagnoses. However, coders should not assume that rheumatic fever is the default cause of valve disease or disorders. Mitral valve disease can be caused by rheumatic fever, but there are other causes as well.

If the documentation mentions a condition like aortic stenosis but doesn鈥檛 specify whether rheumatic or non-rheumatic, your best trick is to query the provider. Some providers or practices may establish a policy that these conditions should be assumed to be non-rheumatic unless the provider explicitly mentions 鈥渞heumatic鈥� in the documentation, but make sure everyone is on the same page before you code accordingly.

Look to the following ICD-10-CM codes when reporting rheumatic valve disorders:

• I05.0 (Rheumatic mitral stenosis) to I05.9 (Rheumatic mitral valve disease, unspecified)
• I06.0 (Rheumatic aortic stenosis) to I06.9 (Rheumatic aortic valve disease, unspecified)
• I07.0 (Rheumatic tricuspid stenosis) to I07.9 (Rheumatic tricuspid valve disease, unspecified)
• I08.0 (Rheumatic disorders of both mitral and aortic valves) through I08.9 (Rheumatic multiple valve disease, unspecified)

Non-rheumatic valve disorders include the following:

• I34.0 (Nonrheumatic mitral (valve) insufficiency) through I34.9 (Nonrheumatic mitral valve disorder, unspecified)
• I35.0 (Nonrheumatic aortic (valve) stenosis) through I35.9 (Nonrheumatic aortic valve disorder, unspecified)
• I36.0 (Nonrheumatic tricuspid (valve) stenosis) through I36.9 (Nonrheumatic tricuspid valve disorder, unspecified)
• I37.0 (Nonrheumatic pulmonary valve stenosis) through I37.9 (Nonrheumatic pulmonary valve disorder, unspecified).

Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, 星空入口