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ICD-10 Guide
ICD-10 CodesI08.1

I08.1

Billable

Rheumatic disorders of both mitral and tricuspid valves

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

Code Description

ICD-10 I08.1 is a billable code used to indicate a diagnosis of rheumatic disorders of both mitral and tricuspid valves.

Key Diagnostic Point:

Rheumatic disorders of both the mitral and tricuspid valves are a result of rheumatic fever, which is 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 tricuspid valve, situated between the right atrium and right ventricle, can both become inflamed and scarred due to rheumatic fever, leading to stenosis or regurgitation. Disease progression can result in significant hemodynamic changes, ultimately leading to congestive heart failure if left untreated. Diagnosis typically involves echocardiography to assess valve function and structure, alongside clinical evaluation and history of rheumatic fever. Additional tests may include electrocardiograms and chest X-rays to evaluate heart size and function. Early intervention is crucial to manage symptoms and prevent further complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors
  • Documentation gaps
  • Billing challenges

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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Rheumatic disorders of the mitral and tricuspid valves significantly impact population health, particularly in regions with high rates of streptococcal infections. These conditions can lead to increased healthcare utilization, including hospitalizations and surgical interventions. Quality measures focus on early diagnosis and treatment of rheumatic fever to prevent valve damage, emphasizing the importance of public health initiatives aimed at reducing the incidence of streptococcal infections.

ICD-9 vs ICD-10

Rheumatic disorders of the mitral and tricuspid valves significantly impact population health, particularly in regions with high rates of streptococcal infections. These conditions can lead to increased healthcare utilization, including hospitalizations and surgical interventions. Quality measures focus on early diagnosis and treatment of rheumatic fever to prevent valve damage, emphasizing the importance of public health initiatives aimed at reducing the incidence of streptococcal infections.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the severity of the condition and the treatment provided. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures. Adhering to coding best practices, such as using the most specific codes and ensuring accurate clinical documentation, can help mitigate these 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 I08.1?

I08.1 encompasses rheumatic heart disease affecting both the mitral and tricuspid valves, including conditions such as rheumatic mitral stenosis, mitral regurgitation, tricuspid stenosis, and tricuspid regurgitation resulting from rheumatic fever.

When should I08.1 be used instead of related codes?

I08.1 should be used when both the mitral and tricuspid valves are affected by rheumatic disease. If only one valve is involved, the appropriate specific code (I05 or I07) should be selected.

What documentation supports I08.1?

Documentation must include a history of rheumatic fever, clinical symptoms, echocardiographic findings demonstrating involvement of both valves, and any treatment plans or interventions undertaken.