Cardiology Coding Alert

Be sure you catch the mitral valve insufficiency twist.

Coding for chronic heart valve diseases is a tricky business. Rheumatic fever is rare in the US these days, but in many cases, ICD-10 requires you to report a rheumatic valve disorder code when documentation doesn’t reveal the disorder’s cause. That rule is inconsistent, though, so you have to know when to default to a nonrheumatic code instead.

Based on a suggestion from Yvette Hofmeister, CPC, senior coder with Ohio State University Physicians, we’ve pulled together some must-know tips and a handy valve disorder table to take the mystery out of coding for these confusing cases.

Hold On to These Top Tips for Valve Disorder Coding

1. Encourage providers to document “not rheumatic” by letting them know that ICD-10 rules may require you to default to reporting a rheumatic code for unspecified diagnoses.
2. Default to rheumatic codes when cause is unspecified for these disorders:

• Mitral valve disorders EXCEPT for insufficiency
• Tricuspid valve disorders
• Multiple valve disorders.

3. Default to nonrheumatic codes when cause is unspecified for these disorders:

• Mitral valve insufficiency
• Aortic valve disorders
• Pulmonary valve disorders (based on Index entry; Tabular does not specify).

4. If the patient has multiple valve disease, use combination codes from I08.- when the cause is rheumatic or unspecified.
5. For congenital valve disorders, see Q22.- (Congenital malformations of pulmonary and tricuspid valves), Q23.- (Congenital malformations of aortic and mitral valves), and Q24.8 (Other specified congenital malformations of heart).