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ICD-10 Guide
ICD-10 CodesI01.9

I01.9

Billable

Acute rheumatic heart disease, unspecified

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

Code Description

ICD-10 I01.9 is a billable code used to indicate a diagnosis of acute rheumatic heart disease, unspecified.

Key Diagnostic Point:

Acute rheumatic heart disease (ARHD) is a serious inflammatory condition that can develop following a streptococcal throat infection, particularly in children and adolescents. The condition primarily affects the heart valves, leading to valvular heart disease, and can also impact the myocardium and pericardium. Clinically, patients may present with symptoms such as fever, joint pain, and signs of heart failure, including dyspnea and edema. The disease progression can vary; some patients may recover completely, while others may develop chronic rheumatic heart disease, leading to long-term complications. Diagnostic considerations include a thorough clinical history, physical examination, echocardiography, and laboratory tests to identify streptococcal infection. The absence of specific symptoms or findings may lead to the designation of 'unspecified' in the coding, which reflects the need for further evaluation to determine the exact nature of the heart involvement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough clinical evaluation and may involve multiple specialties.
  • Treatment complexity: Management may include medications, surgical interventions, and long-term follow-up.
  • Documentation requirements: Detailed clinical documentation is necessary to support the diagnosis and treatment plan.
  • Coding specificity: The unspecified nature of the code may lead to challenges in capturing the full clinical picture.

Audit Risk Factors

  • Common coding errors: Misapplication of related codes or failure to document the acute nature of the disease.
  • Documentation gaps: Incomplete clinical notes that do not clearly establish the diagnosis.
  • Billing challenges: Potential for denials due to lack of specificity or insufficient documentation.

Specialty Focus

Medical Specialties

Primary medical specialty: 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

Secondary specialty: 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 has significant clinical implications, particularly in pediatric populations, where it can lead to long-term cardiovascular complications. The condition contributes to healthcare utilization patterns, including hospitalizations and outpatient visits for management of heart failure and valvular disease. Understanding the epidemiology of ARHD is crucial for public health initiatives aimed at preventing streptococcal infections and reducing the incidence of rheumatic fever.

ICD-9 vs ICD-10

Acute rheumatic heart disease has significant clinical implications, particularly in pediatric populations, where it can lead to long-term cardiovascular complications. The condition contributes to healthcare utilization patterns, including hospitalizations and outpatient visits for management of heart failure and valvular disease. Understanding the epidemiology of ARHD is crucial for public health initiatives aimed at preventing streptococcal infections and reducing the incidence of rheumatic fever.

Reimbursement & Billing Impact

Reimbursement may be impacted by the specificity of the diagnosis code used. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for the services rendered. Coders should ensure that all relevant clinical details are captured in the medical record to support the diagnosis and justify the billing of related procedures.

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 I01.9?

I01.9 covers acute rheumatic heart disease that does not specify the type of heart involvement, which may include valvular damage, myocarditis, or pericarditis resulting from rheumatic fever.

When should I01.9 be used instead of related codes?

I01.9 should be used when the specific type of acute rheumatic heart disease is not documented or when the clinical presentation does not fit the criteria for more specific codes.

What documentation supports I01.9?

Documentation should include a confirmed history of streptococcal infection, clinical findings consistent with acute rheumatic fever, and any relevant imaging or laboratory results that support the diagnosis of acute rheumatic heart disease.