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v1.0.0
ICD-10 Guide
ICD-10 CodesI06.1

I06.1

Billable

Rheumatic aortic insufficiency

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

Code Description

ICD-10 I06.1 is a billable code used to indicate a diagnosis of rheumatic aortic insufficiency.

Key Diagnostic Point:

Rheumatic aortic insufficiency is a condition characterized by the inability of the aortic valve to close properly, leading to backflow of blood from the aorta into the left ventricle during diastole. This condition typically arises as a sequela of rheumatic fever, which is a complication of untreated streptococcal throat infection. Clinically, patients may present with symptoms such as dyspnea, fatigue, palpitations, and signs of heart failure. The anatomy involved includes the aortic valve, left ventricle, and the aorta. Over time, the chronic volume overload can lead to left ventricular hypertrophy and eventual heart failure if left untreated. Diagnosis is often confirmed through echocardiography, which can assess the severity of the regurgitation and the functional status of the left ventricle. Other diagnostic considerations may include chest X-ray, electrocardiogram, and cardiac MRI to evaluate the heart's structure and function.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough evaluation and imaging studies to confirm diagnosis.
  • Treatment complexity: Management may involve medical therapy and potentially surgical intervention.
  • Documentation requirements: Detailed clinical notes and imaging reports are necessary for accurate coding.
  • Coding specificity: Requires precise coding to differentiate from other types of aortic insufficiency.

Audit Risk Factors

  • Common coding errors: Misclassification with other heart conditions or failure to document the rheumatic etiology.
  • Documentation gaps: Incomplete clinical notes regarding symptomatology and diagnostic testing.
  • Billing challenges: Potential denials due to lack of supporting documentation for 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 insufficiency has significant clinical implications, as it can lead to heart failure and increased morbidity if not managed appropriately. The condition is more prevalent in populations with limited access to healthcare and where rheumatic fever is common. Quality measures may include monitoring for timely diagnosis and treatment, which can improve patient outcomes and reduce healthcare utilization. Epidemiologically, the condition highlights the importance of preventive measures against streptococcal infections.

ICD-9 vs ICD-10

Rheumatic aortic insufficiency has significant clinical implications, as it can lead to heart failure and increased morbidity if not managed appropriately. The condition is more prevalent in populations with limited access to healthcare and where rheumatic fever is common. Quality measures may include monitoring for timely diagnosis and treatment, which can improve patient outcomes and reduce healthcare utilization. Epidemiologically, the condition highlights the importance of preventive measures against streptococcal infections.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the condition and the necessity of interventions such as echocardiography or surgical repair. Common denials may arise from insufficient documentation linking the diagnosis to the treatment provided. Best practices include ensuring that all clinical notes are comprehensive and that imaging studies are clearly documented to support the diagnosis and any subsequent billing.

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 I06.1?

I06.1 specifically covers rheumatic aortic insufficiency, which is a result of rheumatic fever. It is important to differentiate this from other causes of aortic insufficiency, such as degenerative or congenital conditions.

When should I06.1 be used instead of related codes?

I06.1 should be used when the aortic insufficiency is specifically due to rheumatic fever. If the insufficiency is due to other causes, such as degenerative changes or other valvular diseases, different codes should be selected.

What documentation supports I06.1?

Documentation should include a history of rheumatic fever, clinical symptoms consistent with aortic insufficiency, and results from echocardiography or other imaging studies that confirm the diagnosis.