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v1.0.0
ICD-10 Guide
DiagnosesAortic Valve Replacement

Aortic Valve Replacement

ICD-10 Coding for Aortic Valve Replacement(I35.0, Z95.2)

PRIMARY SPECIALTYCardiology
COMPLEXITYHigh
LAST UPDATED09/15/2025
Sam Tuffun, PT, DPT
Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Aortic Valve Replacement?
Essential facts and insights about Aortic Valve Replacement

Key Clinical Considerations:

  • Patients typically present with symptoms of aortic stenosis or regurgitation, including dyspnea, angina, and syncope.
  • Echocardiography findings may reveal left ventricular hypertrophy, aortic valve area measurements, and regurgitant flow.
  • Physical examination may show a characteristic systolic ejection murmur or diastolic murmur depending on the type of valve dysfunction.
  • Transesophageal echocardiography or cardiac MRI may be utilized to assess valve morphology and function.
  • Severity is often classified based on echocardiographic measurements of aortic valve area and gradients.

Clinical Information

Clinical Criteria & Documentation Requirements

  • Complete medical history and physical examination findings must be documented in the medical record.
  • Specific terms such as 'aortic stenosis', 'aortic regurgitation', or 'valvular heart disease' should be used.
  • Examples include documenting the patient's symptoms, echocardiogram results, and any functional limitations.
  • Medical necessity must be established through documentation of symptoms, diagnostic findings, and treatment rationale.
  • Quality measures may include documentation of preoperative assessments and postoperative outcomes.

Coding Guidelines

Usage Guidelines & Examples

  • Use I35.0 for aortic valve replacement due to aortic stenosis or regurgitation when surgical intervention is performed.
  • Do not use this code for patients who have aortic valve disease but are not undergoing replacement surgery.
  • Related codes include I35.1 for aortic valve stenosis and I35.2 for aortic valve regurgitation.
  • Common errors include coding for valve replacement without clear documentation of the indication for surgery.
  • In complex cases, ensure to document the specific type of valve disease and any comorbid conditions.

Code Exclusions

Important Exclusions

  • Excludes patients with aortic valve disease who are managed medically without surgical intervention.
  • Alternative codes for excluded conditions may include I34.0 for non-rheumatic mitral valve disorders.
  • Conditions are excluded to ensure accurate representation of surgical interventions and avoid misrepresentation of the patient's clinical status.
  • Common mistakes include coding for valve replacement in patients who are only being monitored or treated conservatively.
  • Related but distinct conditions include mitral valve disorders and other structural heart diseases.

Related ICD-10 Codes

Primary Codes
I35.0
Aortic valve stenosis, unspecified
Z95.2
Presence of aortic valve prosthesis
Ancillary Codes
Z95.2
Differential Codes
I35.1

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Cardiology

Specialty Applications

  • Applies to patients diagnosed with aortic stenosis or regurgitation requiring surgical intervention.
  • Patient populations include older adults, particularly those over 70 years of age, and individuals with risk factors such as hypertension or hyperlipidemia.
  • Clinical settings include inpatient surgical units and outpatient cardiology clinics.
  • Specialty-specific applications are primarily in cardiology and cardiothoracic surgery.
  • Treatment contexts include preoperative evaluations and postoperative management of valve replacement patients.

Coding Complexity

High Complexity

This diagnosis requires careful attention to:

  • Comprehensive clinical documentation
  • Accurate code selection based on clinical criteria
  • Proper exclusion considerations
  • Specialty-specific coding guidelines

Documentation

Documentation Templates

Template 1

Template: 'Patient diagnosed with aortic stenosis based on echocardiographic findings of aortic valve area < 1 cm².'

Template 2

Template: 'Clinical presentation consistent with aortic regurgitation including symptoms of dyspnea and fatigue.'

Template 3

Template: 'Diagnostic criteria for aortic valve replacement met as evidenced by severe stenosis and symptomatic presentation.'

Template 4

Template: 'Treatment plan initiated for aortic stenosis with surgical intervention scheduled for valve replacement.'

Template 5

Template: 'Follow-up care for aortic valve replacement including monitoring for signs of prosthetic valve dysfunction.'

Billing Information

Billing Considerations

  • Ensure proper documentation for billing
  • Verify code specificity requirements
  • Check for any additional codes needed
  • Review payer-specific guidelines

Common Issues

  • Insufficient clinical documentation
  • Incorrect code selection
  • Missing supporting diagnoses
  • Timing and frequency documentation

Frequently Asked Questions

What documentation is required for this diagnosis?

Documentation must include clinical findings, diagnostic test results, and treatment rationale.

How does this differ from similar diagnoses?

Differentiation is based on specific valve involvement and the nature of the dysfunction.

What are common billing considerations?

Ensure that all documentation supports medical necessity and aligns with payer requirements.

What procedures are typically associated?

Commonly associated procedures include echocardiography, cardiac catheterization, and valve replacement surgery.

Are there any quality reporting implications?

Quality measures may include tracking postoperative complications and patient outcomes.