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ICD-10 Guide
DiagnosesAortic Valve Insufficiency

Aortic Valve Insufficiency

ICD-10 Coding for Aortic Valve Insufficiency(I35.1, I06.1, Q23.83)

PRIMARY SPECIALTYCardiology
COMPLEXITYHigh
LAST UPDATED09/15/2025
Sam Tuffun, PT, DPT
Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Aortic Valve Insufficiency?
Essential facts and insights about Aortic Valve Insufficiency

Key Clinical Considerations:

  • Patients may present with symptoms such as dyspnea, fatigue, palpitations, and chest pain.
  • Echocardiography may reveal regurgitation across the aortic valve, left ventricular dilation, and decreased ejection fraction.
  • Physical examination may show a diastolic murmur best heard at the left sternal border, along with signs of heart failure.
  • Transesophageal echocardiography may provide more detailed imaging of the aortic valve structure and function.
  • Severity can be classified as mild, moderate, or severe based on the volume of regurgitant flow and left ventricular function.

Clinical Information

Clinical Criteria & Documentation Requirements

  • Document the patient's symptoms, duration, and any relevant medical history.
  • Use specific terminology such as 'aortic regurgitation' or 'aortic valve insufficiency' consistently.
  • Examples include: 'Patient presents with symptoms consistent with aortic valve insufficiency, including dyspnea on exertion.'
  • Document medical necessity for diagnostic tests and treatments, including rationale for interventions.
  • Quality measures may include documentation of symptom assessment and follow-up care plans.

Coding Guidelines

Usage Guidelines & Examples

  • Use I35.1 for aortic valve insufficiency due to aortic regurgitation; use I06.1 for rheumatic aortic valve insufficiency.
  • Do not use I35.1 for patients with aortic stenosis or other valvular heart diseases without insufficiency.
  • I35.0 (aortic stenosis) and I35.2 (aortic valve stenosis with insufficiency) are related but distinct codes.
  • Common errors include misclassifying the type of valve disease or failing to document the severity.
  • In complex cases, consider the patient's overall cardiac function and any coexisting conditions.

Code Exclusions

Important Exclusions

  • Exclude cases of aortic stenosis without insufficiency (I35.0).
  • Alternative codes for excluded conditions include I35.2 for aortic stenosis with insufficiency.
  • Conditions are excluded based on the specific pathology of the valve dysfunction.
  • Common mistakes include coding aortic stenosis when insufficiency is present without proper documentation.
  • Related but distinct conditions include mitral valve insufficiency and tricuspid valve disorders.

Related ICD-10 Codes

Primary Codes
I35.1
Aortic valve insufficiency
I06.1
Rheumatic aortic valve insufficiency
Q23.83
Other congenital malformations of aortic valve
Ancillary Codes
I50.-
Differential Codes
I06.1
I35.1

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Cardiology

Specialty Applications

  • Applies to patients with aortic valve insufficiency due to degenerative, rheumatic, or congenital causes.
  • Patient populations include adults, particularly those over 60, and individuals with a history of rheumatic fever.
  • Clinical settings include outpatient cardiology clinics, inpatient hospital settings, and emergency departments.
  • Specialty-specific applications are primarily in cardiology, but may also involve cardiac surgery.
  • Used in treatment contexts such as valve repair or replacement surgeries and medical management of heart failure.

Coding Complexity

High Complexity

This diagnosis requires careful attention to:

  • Comprehensive clinical documentation
  • Accurate code selection based on clinical criteria
  • Proper exclusion considerations
  • Specialty-specific coding guidelines

Documentation

Documentation Templates

Template 1

Template: 'Patient diagnosed with aortic valve insufficiency based on echocardiographic findings of regurgitation.'

Template 2

Template: 'Clinical presentation consistent with aortic valve insufficiency including dyspnea and fatigue.'

Template 3

Template: 'Diagnostic criteria for aortic valve insufficiency met as evidenced by echocardiogram showing severe regurgitation.'

Template 4

Template: 'Treatment plan initiated for aortic valve insufficiency with referral for surgical evaluation.'

Template 5

Template: 'Follow-up care for aortic valve insufficiency including monitoring of left ventricular function.'

Billing Information

Billing Considerations

  • Ensure proper documentation for billing
  • Verify code specificity requirements
  • Check for any additional codes needed
  • Review payer-specific guidelines

Common Issues

  • Insufficient clinical documentation
  • Incorrect code selection
  • Missing supporting diagnoses
  • Timing and frequency documentation

Frequently Asked Questions

What documentation is required for this diagnosis?

Detailed documentation of symptoms, diagnostic tests, and treatment plans is required.

How does this differ from similar diagnoses?

Aortic valve insufficiency specifically refers to the inability of the aortic valve to close properly, unlike stenosis.

What are common billing considerations?

Ensure accurate coding based on the type of valve disease and document medical necessity for procedures.

What procedures are typically associated?

Common procedures include echocardiography, cardiac catheterization, and valve repair or replacement.

Are there any quality reporting implications?

Quality measures may include tracking patient outcomes and adherence to treatment guidelines.