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ICD-10 Guide
ICD-10 CodesChapter 9: Diseases of the circulatory systemI07

I07

Non-billable

Rheumatic tricuspid valve diseases

Chapter 9:Diseases of the circulatory system

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

Code Description

ICD-10 I07 is a used to indicate a diagnosis of rheumatic tricuspid valve diseases.

Key Diagnostic Point:

Rheumatic tricuspid valve diseases are a subset of rheumatic heart diseases characterized by inflammation and damage to the tricuspid valve, typically resulting from rheumatic fever, which is a complication of untreated streptococcal throat infections. Clinically, patients may present with symptoms such as fatigue, palpitations, and signs of heart failure, including edema and ascites. The tricuspid valve, located between the right atrium and right ventricle, plays a crucial role in maintaining unidirectional blood flow. Disease progression can lead to tricuspid regurgitation or stenosis, which can exacerbate right-sided heart failure. Diagnosis often involves echocardiography to assess valve morphology and function, alongside clinical evaluation and history of rheumatic fever. Other diagnostic considerations may include electrocardiograms and chest X-rays to evaluate heart size and function. Early identification and management are essential to prevent further cardiac complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors
  • Documentation gaps
  • Billing challenges

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 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 tricuspid valve diseases significantly impact patient quality of life and can lead to increased healthcare utilization due to complications such as heart failure. Understanding the epidemiology of rheumatic heart disease is crucial, as it remains prevalent in certain populations, particularly in developing countries. Quality measures focus on early detection and management to reduce morbidity and mortality associated with these conditions.

ICD-9 vs ICD-10

Rheumatic tricuspid valve diseases significantly impact patient quality of life and can lead to increased healthcare utilization due to complications such as heart failure. Understanding the epidemiology of rheumatic heart disease is crucial, as it remains prevalent in certain populations, particularly in developing countries. Quality measures focus on early detection and management to reduce morbidity and mortality associated with these conditions.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is clearly linked to the services provided. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Coders should ensure that all relevant clinical data is included in the patient's record 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 I07?

I07 covers rheumatic tricuspid valve diseases, including tricuspid regurgitation and tricuspid stenosis resulting from rheumatic fever. It is important to document the history of rheumatic fever and any associated symptoms to support the diagnosis.

When should I07 be used instead of related codes?

I07 should be used when the primary diagnosis is rheumatic disease affecting the tricuspid valve. If the condition is due to non-rheumatic causes, such as degenerative changes or infective endocarditis, other codes should be considered.

What documentation supports I07?

Documentation should include a detailed patient history of rheumatic fever, clinical findings, echocardiographic results, and any treatment plans. Clear evidence of valve dysfunction and its impact on the patient's health is crucial.