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ICD-10 Guide
ICD-10 CodesI23.5

I23.5

Billable

Rupture of papillary muscle as current complication following acute myocardial infarction

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

Code Description

ICD-10 I23.5 is a billable code used to indicate a diagnosis of rupture of papillary muscle as current complication following acute myocardial infarction.

Key Diagnostic Point:

Rupture of the papillary muscle is a serious complication that can occur following an acute myocardial infarction (AMI). The papillary muscles are located in the ventricles of the heart and are attached to the heart valves via chordae tendineae. Their primary function is to prevent the valves from inverting during ventricular contraction. When an AMI occurs, particularly in the inferior wall of the left ventricle, blood supply to the papillary muscle may be compromised, leading to ischemia and potential rupture. Clinically, patients may present with sudden onset of heart failure symptoms, including dyspnea, hypotension, and signs of cardiogenic shock. Diagnosis is typically confirmed through echocardiography, which may reveal mitral valve insufficiency due to the rupture. The progression of this condition can be rapid, necessitating urgent surgical intervention to repair or replace the affected valve. The prognosis is often poor without timely treatment, making early recognition and management critical.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity: Requires advanced imaging techniques for accurate diagnosis.
  • Treatment complexity: Often necessitates surgical intervention, which carries its own risks.
  • Documentation requirements: Detailed clinical notes and imaging reports are essential for accurate coding.
  • Coding specificity: Requires precise coding to differentiate from other myocardial infarction complications.

Audit Risk Factors

  • Common coding errors: Misclassification with other myocardial infarction complications.
  • Documentation gaps: Incomplete clinical notes regarding the timing and nature of the rupture.
  • Billing challenges: Potential denials if 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

Cardiothoracic Surgery

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

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ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of I23.5 lies in its association with high morbidity and mortality rates following myocardial infarction. Early identification and management can significantly improve outcomes. The population health impact is notable, as timely interventions can reduce hospital stays and improve quality of life for affected patients. Understanding this condition is crucial for healthcare providers to enhance care delivery and optimize resource utilization in managing cardiovascular diseases.

ICD-9 vs ICD-10

The clinical significance of I23.5 lies in its association with high morbidity and mortality rates following myocardial infarction. Early identification and management can significantly improve outcomes. The population health impact is notable, as timely interventions can reduce hospital stays and improve quality of life for affected patients. Understanding this condition is crucial for healthcare providers to enhance care delivery and optimize resource utilization in managing cardiovascular diseases.

Reimbursement & Billing Impact

Reimbursement considerations include the need for detailed clinical notes, imaging studies, and any surgical interventions performed. Common denials may arise from insufficient documentation linking the complication to the initial myocardial infarction. Coders should ensure that all relevant clinical information is included to substantiate the medical necessity of procedures performed, as well as to avoid potential audits.

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 I23.5?

I23.5 specifically covers the rupture of the papillary muscle as a complication following an acute myocardial infarction. It is characterized by acute mitral valve insufficiency due to the rupture, leading to severe heart failure symptoms.

When should I23.5 be used instead of related codes?

I23.5 should be used when there is clear evidence of papillary muscle rupture following an acute myocardial infarction, particularly when echocardiographic findings confirm mitral valve insufficiency due to this rupture.

What documentation supports I23.5?

Documentation should include clinical notes detailing the patient's presentation, results from echocardiography showing valve dysfunction, and any surgical reports if applicable. Clear timelines of the myocardial infarction and subsequent complications are crucial.