Valve disorders - coding Rheumatic vs Non-rheumatic

JRhea0715

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At a recent AAPC workshop, we were told to code rheumatic (as opposed to non-rheumatic) if a valve disorder/condition is not specified as rheumatic or non-rheumatic in the physician's dictation. Is this accurate? If so, does anyone know where I can find this in the guidelines/IOM/etc? Really appreciate the help. Thanks!
 

SDAlward

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These are tricky, it took me awhile to fully understand them.

Per a cardiology webinar I attended recently, ICD assumes rheumatic. If it is not specified as non rheumatic, assume rheumatic.

For example, if you look at category I05, within "includes" it specifies "whether specified as rheumatic or not.

If more than one valve is involved (mitral regurgitation with aortic insufficiency) it is always coded as rheumatic. See category I08

you would have to look in the index for each individual valve code, but if it is not specified as non rheumatic, then always assume rheumatic.

Hope this made sense :)
 

JRhea0715

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Thank you!

These are tricky, it took me awhile to fully understand them.

Per a cardiology webinar I attended recently, ICD assumes rheumatic. If it is not specified as non rheumatic, assume rheumatic.

For example, if you look at category I05, within "includes" it specifies "whether specified as rheumatic or not.

If more than one valve is involved (mitral regurgitation with aortic insufficiency) it is always coded as rheumatic. See category I08

you would have to look in the index for each individual valve code, but if it is not specified as non rheumatic, then always assume rheumatic.

Hope this made sense :)


Thank you so much for your response, and thank you for including references to the categories. This really helped a lot. =)
 
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valve disoders

can any one suggest if mitral valve prolapse and multiple valves like mitral, tricuspid , pulmonary regurgitation is present what are the diagnosis we need to capture.whether we need to capture rheumatic or non rheumatic.

Thank you
 

lovelyadd

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can any one suggest if mitral valve prolapse and multiple valves like mitral, tricuspid , pulmonary regurgitation is present what are the diagnosis we need to capture.whether we need to capture rheumatic or non rheumatic.

Thank you

At first, I was coding all separately, if it was just mitral (minus stenosis) and pulmonary; since per guidelines mitral prolapse, mitral reg. and any pulmonary conditions NOS are assumed non-rheumatic. However, per our auditor anytime there is a combination with pulmonary valve to use I08.8. I could never find any documentation to support if either were correct/incorrect. Per guidelines to use the other combo codes (NOS) for mitral, aortic, and tricuspid etc. (I08.0, I08.1, I08.2, I08.3).
 
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zharisma

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Default would be nonrheumatic.
I usually code them separately also for nonrheumatic. but if it is stated rheumatic there's a combi code I08.--

Hope that helps!
 
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