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ICD-10 Guide
ICD-10 CodesI01.1

I01.1

Billable

Acute rheumatic endocarditis

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

Code Description

ICD-10 I01.1 is a billable code used to indicate a diagnosis of acute rheumatic endocarditis.

Key Diagnostic Point:

Acute rheumatic endocarditis is a serious inflammatory condition affecting the heart's inner lining, particularly the heart valves, resulting from rheumatic fever, which is a complication of untreated streptococcal throat infection. Clinically, patients may present with fever, fatigue, heart murmurs, and signs of heart failure. The anatomy involved includes the heart valves, especially the mitral and aortic valves, which can become inflamed and damaged, leading to valvular insufficiency or stenosis. Disease progression can vary; if untreated, it may lead to chronic rheumatic heart disease, which can result in significant morbidity and mortality. Diagnostic considerations include a thorough clinical history, physical examination, echocardiography to assess valve function, and laboratory tests to identify streptococcal infection. Early diagnosis and treatment are crucial to prevent long-term complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires differential diagnosis from other forms of endocarditis and rheumatic fever.
  • Treatment complexity: Involves antibiotic therapy, potential surgical intervention, and management of heart failure.
  • Documentation requirements: Detailed clinical history, evidence of prior streptococcal infection, and echocardiographic findings.
  • Coding specificity: Requires precise coding to differentiate from other types of endocarditis.

Audit Risk Factors

  • Common coding errors: Misclassification with other types of endocarditis or rheumatic fever.
  • Documentation gaps: Incomplete records regarding prior infections or clinical findings.
  • Billing challenges: Potential denials due to lack of supporting documentation for acute rheumatic endocarditis.

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 ICD-10 Codes

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

Acute rheumatic endocarditis has significant clinical implications, as it can lead to long-term heart damage and increased healthcare utilization due to complications. It disproportionately affects children and young adults in developing countries, highlighting the need for effective prevention strategies against streptococcal infections. Quality measures focus on timely diagnosis and treatment to reduce the incidence of rheumatic heart disease, ultimately improving population health outcomes.

ICD-9 vs ICD-10

Acute rheumatic endocarditis has significant clinical implications, as it can lead to long-term heart damage and increased healthcare utilization due to complications. It disproportionately affects children and young adults in developing countries, highlighting the need for effective prevention strategies against streptococcal infections. Quality measures focus on timely diagnosis and treatment to reduce the incidence of rheumatic heart disease, ultimately improving population health outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the need for clear evidence of prior streptococcal infection and the clinical rationale for any procedures performed, such as echocardiograms or surgical interventions. Common denials may arise from insufficient documentation linking the diagnosis to the treatment provided. Best practices include ensuring all clinical findings, laboratory results, and treatment plans are thoroughly documented and clearly correlate with the coding used.

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 I01.1?

I01.1 specifically covers acute rheumatic endocarditis, which is characterized by inflammation of the heart valves due to rheumatic fever following a streptococcal infection. It is essential to differentiate it from other types of endocarditis, such as infective endocarditis caused by bacteria or fungi.

When should I01.1 be used instead of related codes?

I01.1 should be used when there is clear evidence of acute rheumatic endocarditis, particularly following a documented streptococcal infection. It is crucial to differentiate it from I01.0, which does not involve cardiac involvement.

What documentation supports I01.1?

Documentation should include a history of streptococcal infection, clinical symptoms consistent with rheumatic fever, echocardiographic findings indicating valve involvement, and any relevant laboratory tests confirming the diagnosis.