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ICD-10 Guide
ICD-10 CodesI34.2

I34.2

Billable

Nonrheumatic mitral (valve) stenosis

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

Code Description

ICD-10 I34.2 is a billable code used to indicate a diagnosis of nonrheumatic mitral (valve) stenosis.

Key Diagnostic Point:

Nonrheumatic mitral stenosis is a condition characterized by the narrowing of the mitral valve, which impedes blood flow from the left atrium to the left ventricle. This condition can result from various factors, including degenerative changes, calcification, or congenital anomalies. Clinically, patients may present with symptoms such as dyspnea, fatigue, palpitations, and signs of heart failure due to increased left atrial pressure. The anatomy involved includes the mitral valve leaflets, chordae tendineae, and surrounding structures. Over time, untreated mitral stenosis can lead to significant complications, including atrial fibrillation, pulmonary hypertension, and heart failure. Diagnosis typically involves echocardiography, which assesses valve morphology and hemodynamics, and may be supplemented by cardiac catheterization in complex cases. Understanding the progression of the disease is crucial for timely intervention, which may include medical management or surgical options such as balloon valvuloplasty or valve replacement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires echocardiographic evaluation and clinical correlation.
  • Treatment complexity: Management may involve both medical and surgical interventions.
  • Documentation requirements: Comprehensive documentation of symptoms, diagnostic tests, and treatment plans is essential.
  • Coding specificity: Requires accurate coding to differentiate from rheumatic and other types of mitral stenosis.

Audit Risk Factors

  • Common coding errors: Misclassification with rheumatic mitral stenosis or other heart conditions.
  • Documentation gaps: Incomplete clinical notes regarding symptoms and diagnostic tests.
  • Billing challenges: Potential denials if documentation does not support the severity of the condition.

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

Primary Care

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Nonrheumatic mitral stenosis has significant clinical implications, affecting patient quality of life and leading to increased healthcare utilization. It is essential to monitor this condition due to its potential to cause heart failure and other cardiovascular complications. Epidemiologically, the prevalence of mitral stenosis varies, but it is more common in older populations, highlighting the need for effective management strategies to improve outcomes and reduce hospitalizations.

ICD-9 vs ICD-10

Nonrheumatic mitral stenosis has significant clinical implications, affecting patient quality of life and leading to increased healthcare utilization. It is essential to monitor this condition due to its potential to cause heart failure and other cardiovascular complications. Epidemiologically, the prevalence of mitral stenosis varies, but it is more common in older populations, highlighting the need for effective management strategies to improve outcomes and reduce hospitalizations.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the condition and the interventions performed, such as echocardiograms or surgical procedures. Common denials may arise from insufficient documentation of the severity or impact of the condition on the patient's health. Best practices include ensuring that all clinical notes are complete and that the rationale for any procedures is clearly articulated in the medical record.

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 I34.2?

I34.2 specifically covers nonrheumatic mitral stenosis, which can arise from degenerative changes, calcification, or congenital defects, but does not include rheumatic causes.

When should I34.2 be used instead of related codes?

I34.2 should be used when the mitral stenosis is confirmed to be nonrheumatic in origin, differentiating it from I34.1, which is used for rheumatic causes.

What documentation supports I34.2?

Documentation should include clinical findings, echocardiographic results indicating mitral stenosis, and any relevant history that rules out rheumatic disease.