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ICD-10 Guide
ICD-10 CodesI06.9

I06.9

Billable

Rheumatic aortic valve disease, unspecified

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

Code Description

ICD-10 I06.9 is a billable code used to indicate a diagnosis of rheumatic aortic valve disease, unspecified.

Key Diagnostic Point:

Rheumatic aortic valve disease, unspecified, is a condition resulting from rheumatic fever, which is a complication of untreated streptococcal throat infection. This condition primarily affects the aortic valve, leading to either stenosis (narrowing) or regurgitation (leakage), which can significantly impair cardiac function. Clinically, patients may present with symptoms such as dyspnea, fatigue, palpitations, and chest pain. The anatomy involved includes the aortic valve, which is situated between the left ventricle and the aorta, and is crucial for maintaining unidirectional blood flow from the heart to the systemic circulation. Disease progression can lead to heart failure, arrhythmias, and increased risk of infective endocarditis. Diagnostic considerations include echocardiography to assess valve structure and function, along with a thorough history and physical examination to identify prior rheumatic fever episodes. Laboratory tests may also be utilized to detect streptococcal infection and inflammatory markers.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires a comprehensive evaluation of cardiac function and history of rheumatic fever.
  • Treatment complexity: Management may involve medical therapy, monitoring, and potential surgical intervention.
  • Documentation requirements: Detailed clinical notes are necessary to support the diagnosis and treatment plan.
  • Coding specificity: Requires accurate identification of the condition and differentiation from other valvular heart diseases.

Audit Risk Factors

  • Common coding errors: Misclassification of the type of aortic valve disease.
  • Documentation gaps: Incomplete patient history or lack of evidence for rheumatic fever.
  • Billing challenges: Potential denials due to insufficient documentation or unclear 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

Internal Medicine

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

Rheumatic aortic valve disease has significant clinical implications, contributing to morbidity and mortality in affected populations. It is essential for healthcare providers to recognize and manage this condition to improve patient outcomes. Epidemiologically, rheumatic heart disease remains prevalent in developing countries, highlighting the need for preventive measures against streptococcal infections. Quality measures should focus on early diagnosis and appropriate management to reduce the burden of heart failure and improve overall cardiovascular health.

ICD-9 vs ICD-10

Rheumatic aortic valve disease has significant clinical implications, contributing to morbidity and mortality in affected populations. It is essential for healthcare providers to recognize and manage this condition to improve patient outcomes. Epidemiologically, rheumatic heart disease remains prevalent in developing countries, highlighting the need for preventive measures against streptococcal infections. Quality measures should focus on early diagnosis and appropriate management to reduce the burden of heart failure and improve overall cardiovascular health.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is clearly linked to the services provided. Common denials may arise from insufficient documentation or lack of clarity in the medical necessity of the services rendered. Coders should ensure that all relevant clinical information is included in the medical record to support the diagnosis and any associated 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 I06.9?

I06.9 encompasses unspecified rheumatic aortic valve disease, which may include both stenosis and regurgitation resulting from rheumatic fever. It is important to note that the code does not specify the severity or exact nature of the valve dysfunction.

When should I06.9 be used instead of related codes?

I06.9 should be used when the specific type of rheumatic aortic valve disease is not documented. If the clinical documentation specifies stenosis or regurgitation, then I06.0 or I06.1 should be used respectively.

What documentation supports I06.9?

Documentation should include a history of rheumatic fever, clinical symptoms, echocardiographic findings, and any relevant laboratory tests indicating prior streptococcal infection. Comprehensive notes from the healthcare provider detailing the patient's condition and treatment plan are essential.