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ICD-10 Guide
ICD-10 CodesI36.2

I36.2

Billable

Nonrheumatic tricuspid (valve) stenosis with insufficiency

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

Code Description

ICD-10 I36.2 is a billable code used to indicate a diagnosis of nonrheumatic tricuspid (valve) stenosis with insufficiency.

Key Diagnostic Point:

Nonrheumatic tricuspid valve stenosis with insufficiency is a condition characterized by the narrowing (stenosis) of the tricuspid valve, which impedes blood flow from the right atrium to the right ventricle, combined with the valve's inability to close properly (insufficiency). This dual pathology can lead to increased pressure in the right atrium, resulting in symptoms such as fatigue, palpitations, and peripheral edema. The tricuspid valve, located between the right atrium and right ventricle, plays a crucial role in maintaining proper blood flow within the heart. Over time, the stenosis can lead to right heart failure if left untreated. Diagnostic considerations include echocardiography to assess valve morphology and function, as well as cardiac catheterization in complex cases. Clinicians must consider the patient's history, including any prior cardiac conditions or surgeries, to accurately diagnose and manage this condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging studies and possibly invasive procedures for accurate diagnosis.
  • Treatment complexity: Management may involve medical therapy, surgical intervention, or catheter-based procedures.
  • Documentation requirements: Detailed clinical documentation is necessary to support the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to differentiate from other heart valve disorders.

Audit Risk Factors

  • Common coding errors: Misclassification with other valve disorders or failure to document insufficiency.
  • Documentation gaps: Incomplete clinical notes regarding symptoms or diagnostic tests.
  • Billing challenges: Potential denials if documentation does not clearly support the diagnosis or if the treatment plan is not well articulated.

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

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

The clinical significance of I36.2 lies in its potential to lead to serious complications, including right heart failure and arrhythmias, if not managed appropriately. The population health impact is notable, as tricuspid valve disorders can contribute to increased healthcare utilization, including hospital admissions and surgical interventions. Quality measures related to the management of heart valve diseases emphasize the importance of timely diagnosis and appropriate treatment to improve patient outcomes and reduce morbidity associated with cardiovascular conditions.

ICD-9 vs ICD-10

The clinical significance of I36.2 lies in its potential to lead to serious complications, including right heart failure and arrhythmias, if not managed appropriately. The population health impact is notable, as tricuspid valve disorders can contribute to increased healthcare utilization, including hospital admissions and surgical interventions. Quality measures related to the management of heart valve diseases emphasize the importance of timely diagnosis and appropriate treatment to improve patient outcomes and reduce morbidity associated with cardiovascular conditions.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the complexity of the case and the interventions performed. Common denials can occur if the documentation does not clearly establish the medical necessity of the procedures or if the diagnosis is not supported by sufficient clinical evidence. Adhering to coding best practices and ensuring comprehensive documentation can mitigate these risks.

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 I36.2?

I36.2 covers nonrheumatic tricuspid valve stenosis accompanied by insufficiency. This includes cases where the stenosis is due to congenital defects, degenerative changes, or other non-rheumatic causes.

When should I36.2 be used instead of related codes?

I36.2 should be used when there is clear evidence of tricuspid valve stenosis with accompanying insufficiency, differentiating it from other valve disorders such as mitral or aortic valve conditions.

What documentation supports I36.2?

Documentation should include echocardiographic findings indicating tricuspid stenosis and insufficiency, clinical symptoms, and any relevant history of heart disease or prior interventions.