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v1.0.0
ICD-10 Guide
ICD-10 CodesI06.0

I06.0

Billable

Rheumatic aortic stenosis

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

Code Description

ICD-10 I06.0 is a billable code used to indicate a diagnosis of rheumatic aortic stenosis.

Key Diagnostic Point:

Rheumatic aortic stenosis is a heart condition characterized by the narrowing of the aortic valve, which impedes blood flow from the heart into the aorta and subsequently to the rest of the body. This condition is a consequence of rheumatic fever, which often arises from untreated streptococcal throat infections. Clinically, patients may present with symptoms such as exertional dyspnea, fatigue, chest pain, and syncope. The anatomy involved includes the aortic valve, which consists of three cusps that may become calcified or fibrotic due to the inflammatory process initiated by rheumatic fever. Over time, the stenosis can lead to left ventricular hypertrophy and heart failure due to the increased workload on the heart. Diagnostic considerations include echocardiography, which can assess the severity of the stenosis, and Doppler studies to evaluate blood flow across the valve. Other imaging modalities may be utilized to rule out other cardiac conditions and assess overall heart function.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires echocardiographic evaluation and clinical correlation.
  • Treatment complexity: May involve medical management or surgical intervention, such as valve replacement.
  • Documentation requirements: Detailed clinical history and diagnostic imaging reports are essential.
  • Coding specificity: Requires accurate coding to differentiate from other types of aortic stenosis.

Audit Risk Factors

  • Common coding errors: Misidentification of stenosis type or severity.
  • Documentation gaps: Incomplete clinical history or lack of imaging reports.
  • Billing challenges: Denials may occur if the documentation does not clearly support the diagnosis.

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

Internal Medicine

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Rheumatic aortic stenosis significantly impacts population health, particularly in regions where rheumatic fever is prevalent. It contributes to increased healthcare utilization due to hospitalizations for heart failure and surgical interventions. Quality measures related to the management of aortic stenosis focus on timely diagnosis and appropriate treatment, which can improve patient outcomes and reduce morbidity associated with this condition.

ICD-9 vs ICD-10

Rheumatic aortic stenosis significantly impacts population health, particularly in regions where rheumatic fever is prevalent. It contributes to increased healthcare utilization due to hospitalizations for heart failure and surgical interventions. Quality measures related to the management of aortic stenosis focus on timely diagnosis and appropriate treatment, which can improve patient outcomes and reduce morbidity associated with this condition.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the severity of the condition and the treatment approach, whether medical management or surgical intervention. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures related to the aortic stenosis. Coders should ensure that all relevant clinical information is captured to support the diagnosis and any associated procedures.

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 I06.0?

I06.0 specifically covers rheumatic aortic stenosis, which is a narrowing of the aortic valve due to rheumatic fever. It is important to differentiate it from degenerative aortic stenosis or congenital aortic stenosis.

When should I06.0 be used instead of related codes?

I06.0 should be used when the aortic stenosis is specifically due to rheumatic fever. If the stenosis is due to other causes, such as degenerative changes or congenital defects, other codes should be selected.

What documentation supports I06.0?

Documentation should include a history of rheumatic fever, clinical symptoms consistent with aortic stenosis, and echocardiographic findings that confirm the diagnosis of rheumatic aortic stenosis.