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ICD-10 Guide
ICD-10 CodesChapter 9: Diseases of the circulatory systemI01

I01

Non-billable

Rheumatic fever with heart involvement

Chapter 9:Diseases of the circulatory system

BILLABLE STATUSNo
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 I01 is a used to indicate a diagnosis of rheumatic fever with heart involvement.

Key Diagnostic Point:

Rheumatic fever with heart involvement is a serious inflammatory condition that can develop as a complication of untreated streptococcal throat infection. Clinically, it presents with symptoms such as fever, joint pain, and carditis, which may manifest as murmurs, heart failure, or arrhythmias. The heart involvement can lead to rheumatic heart disease, characterized by damage to the heart valves, particularly the mitral and aortic valves. The disease progression can vary, with some patients experiencing acute symptoms while others may develop chronic complications over time. Diagnostic considerations include a thorough history of streptococcal infections, physical examination findings, echocardiography to assess valve function, and laboratory tests such as throat cultures and anti-streptolysin O titers. Early diagnosis and treatment are crucial to prevent long-term cardiac damage.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires a comprehensive assessment of clinical history and symptoms.
  • Treatment complexity: Involves long-term management strategies including antibiotics and possibly surgical interventions.
  • Documentation requirements: Detailed documentation of clinical findings and treatment plans is essential.
  • Coding specificity: Requires precise coding to differentiate from other rheumatic conditions.

Audit Risk Factors

  • Common coding errors: Misclassification of rheumatic fever without heart involvement.
  • Documentation gaps: Incomplete records of prior streptococcal infections or clinical findings.
  • Billing challenges: Potential denials due to lack of supporting documentation for heart involvement.

Specialty Focus

Medical Specialties

Cardiology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Infectious Disease

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Rheumatic fever with heart involvement significantly impacts population health, particularly in areas with high rates of streptococcal infections. It can lead to long-term health issues, including heart failure and increased healthcare utilization due to complications. Quality measures focus on timely diagnosis and treatment to prevent rheumatic heart disease, emphasizing the importance of public health initiatives aimed at reducing streptococcal infections.

ICD-9 vs ICD-10

Rheumatic fever with heart involvement significantly impacts population health, particularly in areas with high rates of streptococcal infections. It can lead to long-term health issues, including heart failure and increased healthcare utilization due to complications. Quality measures focus on timely diagnosis and treatment to prevent rheumatic heart disease, emphasizing the importance of public health initiatives aimed at reducing streptococcal infections.

Reimbursement & Billing Impact

Reimbursement considerations include the need for comprehensive records that justify the diagnosis and any associated procedures. Common denials may arise from insufficient documentation linking the rheumatic fever to heart involvement, so coders should ensure that all relevant clinical information is included. Best practices include regular audits of documentation and coding accuracy to minimize billing issues.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for I00-I99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for I00-I99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by I01?

I01 covers rheumatic fever with documented heart involvement, including conditions such as rheumatic heart disease, valvular heart disease due to rheumatic fever, and acute rheumatic carditis.

When should I01 be used instead of related codes?

I01 should be used when there is clear evidence of heart involvement in a patient diagnosed with rheumatic fever, differentiating it from I00, which does not include cardiac manifestations.

What documentation supports I01?

Documentation should include a history of streptococcal infection, clinical findings of carditis, echocardiographic evidence of valve involvement, and treatment plans addressing both the fever and cardiac issues.