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ICD-10 Guide
ICD-10 CodesI08.0

I08.0

Billable

Rheumatic disorders of both mitral and aortic valves

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

Code Description

ICD-10 I08.0 is a billable code used to indicate a diagnosis of rheumatic disorders of both mitral and aortic valves.

Key Diagnostic Point:

I08.0 refers to rheumatic disorders affecting both the mitral and aortic valves, which are critical components of the heart's anatomy. These conditions arise as a result of rheumatic fever, a complication of untreated streptococcal throat infections. Clinically, patients may present with symptoms such as dyspnea, fatigue, palpitations, and signs of heart failure. The mitral valve, located between the left atrium and left ventricle, and the aortic valve, situated between the left ventricle and the aorta, can both become stenotic or regurgitant due to rheumatic changes. Disease progression often leads to chronic heart failure and can significantly impact quality of life. Diagnostic considerations include echocardiography to assess valve function and structure, as well as clinical history and physical examination findings. Early recognition and management are crucial to prevent severe complications such as arrhythmias or endocarditis.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires comprehensive evaluation including imaging and clinical history.
  • Treatment complexity: Management may involve medications, surgical interventions, and long-term follow-up.
  • Documentation requirements: Detailed clinical documentation is necessary to support diagnosis and treatment.
  • Coding specificity: Requires precise coding to differentiate from other rheumatic heart diseases.

Audit Risk Factors

  • Common coding errors: Misidentification of the specific valve affected can lead to incorrect coding.
  • Documentation gaps: Incomplete clinical notes may not support the diagnosis of both valves being affected.
  • Billing challenges: Denials may occur if the clinical rationale for the diagnosis is not clearly documented.

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

Rheumatology

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

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CPT Code

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Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of I08.0 is profound, as rheumatic heart disease remains a leading cause of cardiovascular morbidity in developing countries. Its impact on population health includes increased hospitalizations and healthcare costs associated with heart failure management. Quality measures focus on early detection and treatment of rheumatic fever to prevent valve damage. Epidemiologically, the prevalence of rheumatic heart disease highlights the need for improved access to healthcare and preventive measures against streptococcal infections.

ICD-9 vs ICD-10

The clinical significance of I08.0 is profound, as rheumatic heart disease remains a leading cause of cardiovascular morbidity in developing countries. Its impact on population health includes increased hospitalizations and healthcare costs associated with heart failure management. Quality measures focus on early detection and treatment of rheumatic fever to prevent valve damage. Epidemiologically, the prevalence of rheumatic heart disease highlights the need for improved access to healthcare and preventive measures against streptococcal infections.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of care provided, the necessity of surgical interventions, and ongoing management of heart failure symptoms. Common denials may arise from insufficient documentation linking the diagnosis to the treatment provided. Best practices include ensuring all clinical notes are complete and accurately reflect the patient's condition 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 I08.0?

I08.0 encompasses rheumatic heart disease affecting both the mitral and aortic valves, typically resulting from rheumatic fever. This includes conditions such as mitral stenosis, mitral regurgitation, aortic stenosis, and aortic regurgitation that are secondary to rheumatic etiology.

When should I08.0 be used instead of related codes?

I08.0 should be used when both the mitral and aortic valves are involved in rheumatic disease. If only one valve is affected, the specific codes I08.1 or I08.2 should be utilized.

What documentation supports I08.0?

Documentation should include a detailed history of rheumatic fever, clinical findings from physical examinations, echocardiographic results demonstrating valve involvement, and any relevant laboratory tests indicating streptococcal infection.