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ICD-10 Guide
ICD-10 CodesI01.2

I01.2

Billable

Acute rheumatic myocarditis

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

Code Description

ICD-10 I01.2 is a billable code used to indicate a diagnosis of acute rheumatic myocarditis.

Key Diagnostic Point:

Acute rheumatic myocarditis is an inflammatory condition of the myocardium that occurs as a complication of rheumatic fever, which is a sequela of untreated streptococcal throat infection. Clinically, patients may present with symptoms such as chest pain, palpitations, dyspnea, and signs of heart failure. The inflammation primarily affects the heart muscle, leading to impaired cardiac function. The disease progression can vary, with some patients experiencing rapid deterioration, while others may have a more insidious onset. Diagnosis is typically confirmed through clinical evaluation, echocardiography, and laboratory tests, including elevated inflammatory markers and evidence of recent streptococcal infection. It is crucial to differentiate acute rheumatic myocarditis from other forms of myocarditis and cardiac conditions, as management strategies differ significantly.

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

Infectious Disease

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

Acute rheumatic myocarditis has significant clinical implications, particularly in pediatric populations where rheumatic fever is more prevalent. The condition can lead to long-term cardiovascular complications, affecting population health outcomes. Quality measures related to the timely diagnosis and treatment of rheumatic fever can help reduce the incidence of myocarditis. Understanding healthcare utilization patterns is essential for improving management strategies and reducing hospitalizations associated with this condition.

ICD-9 vs ICD-10

Acute rheumatic myocarditis has significant clinical implications, particularly in pediatric populations where rheumatic fever is more prevalent. The condition can lead to long-term cardiovascular complications, affecting population health outcomes. Quality measures related to the timely diagnosis and treatment of rheumatic fever can help reduce the incidence of myocarditis. Understanding healthcare utilization patterns is essential for improving management strategies and reducing hospitalizations associated with this condition.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the severity of the condition and the complexity of care provided. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. It is crucial to ensure that all relevant clinical information is included in the patient's record to support the coding and billing process effectively.

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 I01.2?

I01.2 specifically covers acute rheumatic myocarditis, which is characterized by inflammation of the heart muscle due to rheumatic fever. It is essential to confirm the diagnosis through clinical criteria and laboratory findings related to streptococcal infection.

When should I01.2 be used instead of related codes?

I01.2 should be used when the patient presents with myocarditis specifically linked to rheumatic fever. If the myocarditis is due to other causes, such as viral infections or autoimmune diseases, other codes should be selected.

What documentation supports I01.2?

Documentation should include clinical findings, laboratory results indicating streptococcal infection, echocardiographic evidence of myocardial involvement, and a clear history of rheumatic fever.