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ICD-10 Guide
ICD-10 CodesI01.8

I01.8

Billable

Other acute rheumatic heart disease

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

Code Description

ICD-10 I01.8 is a billable code used to indicate a diagnosis of other acute rheumatic heart disease.

Key Diagnostic Point:

Other acute rheumatic heart disease refers to a group of conditions that arise from rheumatic fever, which is a complication of untreated streptococcal throat infection. Clinically, patients may present with symptoms such as fever, joint pain, and signs of heart involvement, including murmurs or heart failure. The anatomy involved primarily includes the heart valves, particularly the mitral and aortic valves, which may become inflamed and damaged. Disease progression can lead to chronic rheumatic heart disease if not adequately treated, resulting in long-term complications such as valvular stenosis or regurgitation. Diagnostic considerations include a thorough clinical history, physical examination, echocardiography, and laboratory tests to identify streptococcal infection. Early recognition and treatment are crucial to prevent further cardiac damage and improve patient outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires a comprehensive assessment of symptoms and history of rheumatic fever.
  • Treatment complexity: Involves managing acute symptoms and preventing recurrence with antibiotics and possibly surgical intervention.
  • Documentation requirements: Detailed clinical documentation is necessary to support the diagnosis and treatment plan.
  • Coding specificity: Requires accurate coding to differentiate from other types of rheumatic heart disease.

Audit Risk Factors

  • Common coding errors: Misclassification of acute versus chronic conditions.
  • Documentation gaps: Incomplete patient history or lack of evidence for rheumatic fever.
  • Billing challenges: Potential denials due to insufficient documentation or incorrect coding.

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 heart disease significantly impacts population health, particularly in regions with high rates of streptococcal infections. It can lead to long-term cardiovascular complications, increasing healthcare utilization due to hospitalizations and surgeries. Quality measures focus on the prevention of rheumatic fever through timely treatment of streptococcal infections, which can reduce the incidence of rheumatic heart disease. Epidemiologically, understanding the prevalence and risk factors associated with rheumatic heart disease is crucial for public health initiatives aimed at reducing its burden.

ICD-9 vs ICD-10

Acute rheumatic heart disease significantly impacts population health, particularly in regions with high rates of streptococcal infections. It can lead to long-term cardiovascular complications, increasing healthcare utilization due to hospitalizations and surgeries. Quality measures focus on the prevention of rheumatic fever through timely treatment of streptococcal infections, which can reduce the incidence of rheumatic heart disease. Epidemiologically, understanding the prevalence and risk factors associated with rheumatic heart disease is crucial for public health initiatives aimed at reducing its burden.

Reimbursement & Billing Impact

reimbursement considerations include the necessity of demonstrating medical necessity for diagnostic tests and treatments. It is essential to use the correct CPT codes that correspond to the services provided, as improper coding can lead to claim denials. Best practices include thorough documentation of the patient's history, clinical findings, and treatment rationale.

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 I01.8?

I01.8 encompasses various forms of acute rheumatic heart disease not classified elsewhere, including cases with valvular involvement that do not fit into more specific categories. It may include acute rheumatic myocarditis or pericarditis secondary to rheumatic fever.

When should I01.8 be used instead of related codes?

I01.8 should be used when the acute rheumatic heart disease does not fit into the more specific categories like I01.0 or I01.1, particularly when the clinical presentation is atypical or involves multiple heart structures.

What documentation supports I01.8?

Documentation should include a confirmed diagnosis of rheumatic fever, clinical symptoms indicating heart involvement, echocardiographic findings, and any relevant laboratory results confirming streptococcal infection.