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ICD-10 Guide
ICD-10 CodesI36.8

I36.8

Billable

Other nonrheumatic tricuspid valve disorders

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

Code Description

ICD-10 I36.8 is a billable code used to indicate a diagnosis of other nonrheumatic tricuspid valve disorders.

Key Diagnostic Point:

I36.8 refers to other nonrheumatic tricuspid valve disorders, which encompass a variety of conditions affecting the tricuspid valve that are not related to rheumatic fever. The tricuspid valve, located between the right atrium and right ventricle of the heart, plays a crucial role in maintaining proper blood flow within the heart. Disorders of this valve can lead to significant clinical manifestations, including tricuspid regurgitation, stenosis, or other structural abnormalities. Symptoms may vary from mild to severe and can include fatigue, palpitations, peripheral edema, and signs of right heart failure. The progression of these disorders can lead to increased cardiac workload and eventual heart failure if left untreated. Diagnosis typically involves echocardiography, which provides detailed imaging of valve structure and function, along with clinical evaluation and history. Other diagnostic tools may include cardiac MRI or CT scans to assess the anatomy and function of the heart and valves. Accurate diagnosis is essential for effective management and treatment planning.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough evaluation and imaging studies to differentiate from other cardiac conditions.
  • Treatment complexity: Management may involve medical therapy or surgical intervention, depending on severity.
  • Documentation requirements: Comprehensive documentation of symptoms, diagnostic tests, and treatment plans is necessary.
  • Coding specificity: Requires precise coding to capture the specific type of tricuspid valve disorder.

Audit Risk Factors

  • Common coding errors: Misclassification of the type of tricuspid valve disorder.
  • Documentation gaps: Incomplete clinical notes or lack of imaging results to support the diagnosis.
  • Billing challenges: Potential for denials if documentation does not clearly justify the use of I36.8.

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of I36.8 lies in its potential to lead to serious complications such as heart failure and arrhythmias if not properly managed. The prevalence of tricuspid valve disorders can impact population health, particularly in patients with underlying cardiovascular diseases. Quality measures related to the management of these conditions are critical for improving patient outcomes and reducing healthcare utilization. Epidemiologically, understanding the incidence and prevalence of nonrheumatic tricuspid valve disorders can aid in resource allocation and healthcare planning.

ICD-9 vs ICD-10

The clinical significance of I36.8 lies in its potential to lead to serious complications such as heart failure and arrhythmias if not properly managed. The prevalence of tricuspid valve disorders can impact population health, particularly in patients with underlying cardiovascular diseases. Quality measures related to the management of these conditions are critical for improving patient outcomes and reducing healthcare utilization. Epidemiologically, understanding the incidence and prevalence of nonrheumatic tricuspid valve disorders can aid in resource allocation and healthcare planning.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the complexity of the disorder and the treatment provided. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures related to the tricuspid valve. Adhering to coding best practices, including accurate code selection and comprehensive documentation, is essential for successful billing.

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 I36.8?

I36.8 covers various nonrheumatic tricuspid valve disorders, including but not limited to tricuspid valve prolapse, congenital abnormalities, and degenerative changes that do not stem from rheumatic fever. Each condition may present with unique symptoms and require specific diagnostic criteria.

When should I36.8 be used instead of related codes?

I36.8 should be used when the tricuspid valve disorder does not fit the criteria for other specific codes such as I36.0 or I36.1. It is important to ensure that the clinical documentation supports the diagnosis of a nonrheumatic disorder.

What documentation supports I36.8?

Documentation for I36.8 should include a detailed clinical history, physical examination findings, results from echocardiography or other imaging studies, and any relevant laboratory tests that support the diagnosis of a nonrheumatic tricuspid valve disorder.