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ICD-10 Guide
ICD-10 CodesI33

I33

Non-billable

Acute and subacute endocarditis

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

Code Description

ICD-10 I33 is a used to indicate a diagnosis of acute and subacute endocarditis.

Key Diagnostic Point:

Acute and subacute endocarditis refers to the inflammation of the inner lining of the heart chambers and valves, typically caused by bacterial infection. Clinically, patients may present with fever, chills, fatigue, and heart murmurs, alongside signs of systemic embolization. The anatomy involved includes the heart valves (mitral, aortic, tricuspid, and pulmonary) and the endocardial surface. Disease progression can vary; acute endocarditis develops rapidly, often leading to severe complications such as heart failure or systemic emboli, while subacute endocarditis progresses more slowly, allowing for more subtle symptoms and potentially less severe outcomes. Diagnostic considerations include blood cultures, echocardiography, and clinical criteria such as the Duke criteria, which help differentiate between acute and subacute forms. Early diagnosis and treatment are critical to prevent serious complications, including valvular damage and septicemia.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough clinical evaluation and laboratory testing.
  • Treatment complexity: Involves prolonged antibiotic therapy and possible surgical intervention.
  • Documentation requirements: Detailed clinical notes and diagnostic criteria must be documented.
  • Coding specificity: Requires accurate coding to differentiate between acute and subacute forms.

Audit Risk Factors

  • Common coding errors: Misclassification between acute and subacute forms.
  • Documentation gaps: Incomplete clinical notes regarding symptoms and diagnostic tests.
  • Billing challenges: Potential denials if documentation does not support the severity or type of 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 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 and subacute endocarditis significantly impacts clinical outcomes and population health, as it can lead to severe complications such as heart failure and systemic embolization. Quality measures often focus on timely diagnosis and appropriate antibiotic therapy. Epidemiologically, endocarditis is associated with certain risk factors, including pre-existing heart conditions and intravenous drug use, highlighting the need for targeted prevention strategies and healthcare utilization patterns.

ICD-9 vs ICD-10

Acute and subacute endocarditis significantly impacts clinical outcomes and population health, as it can lead to severe complications such as heart failure and systemic embolization. Quality measures often focus on timely diagnosis and appropriate antibiotic therapy. Epidemiologically, endocarditis is associated with certain risk factors, including pre-existing heart conditions and intravenous drug use, highlighting the need for targeted prevention strategies and healthcare utilization patterns.

Reimbursement & Billing Impact

Reimbursement considerations include the need for detailed clinical notes, laboratory results, and treatment plans. Common denials may occur if documentation does not clearly establish the diagnosis or if there are discrepancies in the clinical findings. Best practices include ensuring that all relevant tests and treatments are documented and that the coding accurately reflects the severity and type of endocarditis.

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 I33?

I33 covers both acute and subacute endocarditis, which can be caused by various pathogens, including bacteria, fungi, and other microorganisms. It is essential to identify the causative organism for appropriate treatment.

When should I33 be used instead of related codes?

I33 should be used when the patient is diagnosed with acute or subacute endocarditis, characterized by specific clinical findings and diagnostic criteria. It is important to differentiate it from other heart conditions such as I38, which is more general.

What documentation supports I33?

Documentation should include clinical findings such as fever, heart murmurs, and embolic phenomena, along with laboratory results from blood cultures and echocardiography findings that confirm the diagnosis of endocarditis.