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ICD-10 Guide
ICD-10 CodesI07.2

I07.2

Billable

Rheumatic tricuspid stenosis and insufficiency

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

Code Description

ICD-10 I07.2 is a billable code used to indicate a diagnosis of rheumatic tricuspid stenosis and insufficiency.

Key Diagnostic Point:

Rheumatic tricuspid stenosis and insufficiency is a heart condition resulting from rheumatic fever, which can lead to inflammation and scarring of the heart valves. The tricuspid valve, located between the right atrium and right ventricle, can become narrowed (stenosis) or fail to close properly (insufficiency), causing impaired blood flow and increased pressure in the right atrium. Clinically, patients may present with symptoms such as fatigue, palpitations, peripheral edema, and signs of right heart failure. The disease progression can lead to significant complications, including atrial fibrillation and right-sided heart failure. Diagnostic considerations include echocardiography, which is essential for assessing valve morphology and hemodynamic impact, along with clinical history and physical examination findings. Other imaging modalities may be utilized to evaluate the severity of the condition and guide treatment decisions.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough evaluation and imaging to confirm diagnosis.
  • Treatment complexity: Management may involve medical therapy, monitoring, and potential surgical intervention.
  • Documentation requirements: Detailed clinical documentation is necessary to support the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to differentiate from other heart conditions.

Audit Risk Factors

  • Common coding errors: Misclassification of stenosis vs. insufficiency.
  • Documentation gaps: Incomplete clinical notes or lack of imaging results.
  • 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

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 tricuspid stenosis and insufficiency significantly impact patient quality of life and can lead to increased healthcare utilization due to complications such as heart failure. Understanding the epidemiology of rheumatic heart disease is crucial, as it remains prevalent in certain populations, particularly in developing countries. Quality measures focus on early diagnosis and management to prevent disease progression and improve outcomes.

ICD-9 vs ICD-10

Rheumatic tricuspid stenosis and insufficiency significantly impact patient quality of life and can lead to increased healthcare utilization due to complications such as heart failure. Understanding the epidemiology of rheumatic heart disease is crucial, as it remains prevalent in certain populations, particularly in developing countries. Quality measures focus on early diagnosis and management to prevent disease progression and improve outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the condition and the necessity for imaging studies. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures. Best practices include ensuring that all clinical notes are complete and that coding accurately reflects the patient's condition and treatment provided.

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 I07.2?

I07.2 covers rheumatic tricuspid stenosis and insufficiency, which may occur concurrently or separately as a result of rheumatic heart disease. It is characterized by the narrowing of the tricuspid valve and/or its inability to close properly, leading to hemodynamic changes.

When should I07.2 be used instead of related codes?

I07.2 should be used when both stenosis and insufficiency of the tricuspid valve are present. If only one condition is documented, the appropriate specific code should be selected, such as I07.1 for stenosis alone.

What documentation supports I07.2?

Documentation should include a detailed clinical history, physical examination findings, echocardiographic results, and any relevant laboratory tests that support the diagnosis of rheumatic tricuspid stenosis and insufficiency.