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ICD-10 Guide
ICD-10 CodesI07.9

I07.9

Billable

Rheumatic tricuspid valve disease, unspecified

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

Code Description

ICD-10 I07.9 is a billable code used to indicate a diagnosis of rheumatic tricuspid valve disease, unspecified.

Key Diagnostic Point:

Rheumatic tricuspid valve disease, unspecified, refers to a condition where the tricuspid valve, located between the right atrium and right ventricle of the heart, is affected by rheumatic fever, a complication of untreated streptococcal throat infection. Clinically, patients may present with symptoms such as fatigue, palpitations, and signs of right heart failure, including peripheral edema and ascites. The disease progression can lead to tricuspid regurgitation or stenosis, resulting in increased right atrial pressure and potential right ventricular hypertrophy. Diagnostic considerations include echocardiography to assess valve morphology and function, along with clinical history and physical examination findings. It is crucial to differentiate this condition from other valvular heart diseases, as management strategies may vary significantly based on the specific valve involvement and severity of the disease.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough clinical evaluation and imaging studies.
  • Treatment complexity: Management may involve medical therapy or surgical intervention depending on severity.
  • Documentation requirements: Detailed clinical history and echocardiographic findings are necessary.
  • Coding specificity: Requires accurate identification of rheumatic etiology and valve involvement.

Audit Risk Factors

  • Common coding errors: Misclassification of rheumatic vs. degenerative valve disease.
  • Documentation gaps: Incomplete clinical history or lack of echocardiographic evidence.
  • Billing challenges: Potential denials due to insufficient specificity in 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 valve disease can significantly affect patient quality of life and may lead to increased healthcare utilization due to complications such as heart failure. Understanding the epidemiology of rheumatic heart disease is crucial, as it remains a significant public health issue in developing countries. Quality measures related to timely diagnosis and management can improve outcomes and reduce the burden on healthcare systems.

ICD-9 vs ICD-10

Rheumatic tricuspid valve disease can significantly affect patient quality of life and may lead to increased healthcare utilization due to complications such as heart failure. Understanding the epidemiology of rheumatic heart disease is crucial, as it remains a significant public health issue in developing countries. Quality measures related to timely diagnosis and management can improve outcomes and reduce the burden on healthcare systems.

Reimbursement & Billing Impact

Reimbursement may vary based on the severity of the condition and associated treatments. Common denials may arise from insufficient documentation or lack of specificity in the diagnosis. Coders should ensure that the medical necessity for any procedures or consultations is clearly documented to avoid billing challenges.

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 I07.9?

I07.9 covers unspecified rheumatic tricuspid valve disease, which may include tricuspid regurgitation or stenosis due to rheumatic fever without further specification of the condition's severity or type.

When should I07.9 be used instead of related codes?

I07.9 should be used when the specific type of rheumatic tricuspid valve disease is not documented or when the clinical presentation does not allow for a more specific diagnosis.

What documentation supports I07.9?

Documentation should include a comprehensive clinical evaluation, echocardiographic findings indicating tricuspid valve involvement, and a history of rheumatic fever or related symptoms.