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ICD-10 Guide
ICD-10 CodesI36.9

I36.9

Billable

Nonrheumatic tricuspid valve disorder, unspecified

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

Code Description

ICD-10 I36.9 is a billable code used to indicate a diagnosis of nonrheumatic tricuspid valve disorder, unspecified.

Key Diagnostic Point:

Nonrheumatic tricuspid valve disorder, unspecified, refers to a range of conditions affecting the tricuspid valve that are not caused by rheumatic fever. The tricuspid valve is located between the right atrium and right ventricle of the heart, playing a crucial role in regulating blood flow. Clinical presentations may include symptoms of heart failure, such as fatigue, edema, and palpitations, often resulting from valve stenosis or regurgitation. Disease progression can lead to right-sided heart failure if left untreated. Diagnostic considerations include echocardiography, which is essential for assessing valve structure and function, and may be complemented by cardiac MRI or CT scans for detailed imaging. Laboratory tests may also be performed to evaluate underlying causes, such as infections or congenital defects. Given the unspecified nature of this code, it is critical for healthcare providers to document the clinical context thoroughly to guide appropriate management and treatment strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors
  • Documentation gaps
  • Billing challenges

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

Internal Medicine

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

Nonrheumatic tricuspid valve disorders can significantly affect patient quality of life and may lead to increased healthcare utilization due to complications such as heart failure. Understanding the epidemiology of these conditions is vital for population health management, as they may be underdiagnosed in certain demographics. Quality measures focusing on timely diagnosis and management can improve patient outcomes and reduce the burden on healthcare systems.

ICD-9 vs ICD-10

Nonrheumatic tricuspid valve disorders can significantly affect patient quality of life and may lead to increased healthcare utilization due to complications such as heart failure. Understanding the epidemiology of these conditions is vital for population health management, as they may be underdiagnosed in certain demographics. Quality measures focusing on timely diagnosis and management can improve patient outcomes and reduce the burden on healthcare systems.

Reimbursement & Billing Impact

reimbursement.

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 I36.9?

I36.9 encompasses various nonrheumatic tricuspid valve disorders, including but not limited to tricuspid regurgitation, stenosis, and other functional abnormalities not attributed to rheumatic fever. It is essential to evaluate the patient's clinical presentation to determine the underlying etiology.

When should I36.9 be used instead of related codes?

I36.9 should be used when the specific type of tricuspid valve disorder is not clearly defined or documented. If a more specific diagnosis is available, such as tricuspid stenosis or regurgitation, the corresponding codes (I36.0 or I36.1) should be utilized.

What documentation supports I36.9?

Documentation should include a detailed clinical assessment, echocardiographic findings, and any relevant laboratory results. It is crucial to note the absence of rheumatic etiology and any symptoms experienced by the patient to support the use of I36.9.