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ICDxICD-10 Medical Coding

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v1.0.0
ICD-10 Guide
ICD-10 CodesR01

R01

Cardiac murmurs and other cardiac sounds

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 R01 is a billable code used to indicate a diagnosis of cardiac murmurs and other cardiac sounds.

Key Diagnostic Point:

Cardiac murmurs are abnormal sounds produced by turbulent blood flow within the heart or great vessels. They can be classified as either innocent (physiologic) or pathological. Innocent murmurs are common in children and often resolve with age, while pathological murmurs may indicate underlying heart conditions such as valvular heart disease, congenital heart defects, or heart failure. Other cardiac sounds may include rubs, clicks, or gallops, which can also signify various cardiac conditions. The presence of a murmur is often detected during a routine physical examination and may warrant further investigation through echocardiography or other imaging modalities to determine the underlying cause. Accurate diagnosis and management depend on the clinical context, patient history, and associated symptoms such as dyspnea, chest pain, or syncope.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between innocent and pathological murmurs
  • Need for thorough clinical evaluation and history taking
  • Potential for multiple underlying causes
  • Variability in documentation practices among providers

Audit Risk Factors

  • Inadequate documentation of the type and significance of the murmur
  • Failure to specify associated symptoms or clinical findings
  • Misclassification of innocent murmurs as pathological
  • Lack of follow-up documentation for further diagnostic testing

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed history of present illness, physical exam findings, and any diagnostic tests performed.

Common Clinical Scenarios

Evaluation of a patient with a newly discovered murmur during a routine check-up.

Billing Considerations

Consideration of patient age, history of heart disease, and associated symptoms is crucial for accurate coding.

Emergency Medicine

Documentation Requirements

Acute care documentation including vital signs, immediate assessment findings, and any interventions performed.

Common Clinical Scenarios

A patient presenting with chest pain and a newly detected murmur requiring urgent evaluation.

Billing Considerations

Rapid assessment and documentation of the murmur's characteristics and associated symptoms are essential.

Coding Guidelines

Inclusion Criteria

Use R01 When
  • Coders should refer to the official ICD
  • CM guidelines, ensuring that the code is used only when the murmur is documented and clinically significant
  • Documentation must support the diagnosis and any associated conditions

Exclusion Criteria

Do NOT use R01 When
No specific exclusions found.

Related Codes

Child Codes

3 codes
R01.0
Benign and innocent cardiac murmurs
R01.1
Cardiac murmur, unspecified
R01.2
Other cardiac sounds

Related CPT Codes

93306CPT Code

Echocardiography, transthoracic, real-time with interpretation and report

Clinical Scenario

Used when further evaluation of a murmur is warranted.

Documentation Requirements

Documentation of the indication for the echocardiogram and findings.

Specialty Considerations

Cardiology specialists may require more detailed reports.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of cardiac murmurs, improving the granularity of data for clinical research and quality improvement initiatives.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of cardiac murmurs, improving the granularity of data for clinical research and quality improvement initiatives.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of cardiac murmurs, improving the granularity of data for clinical research and quality improvement initiatives.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the difference between an innocent murmur and a pathological murmur?

An innocent murmur is typically harmless and often resolves with age, while a pathological murmur indicates an underlying heart condition that may require further evaluation and management.