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ICD-10 Guide
ICD-10 CodesI08.3

I08.3

Billable

Combined rheumatic disorders of mitral, aortic and tricuspid valves

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

Code Description

ICD-10 I08.3 is a billable code used to indicate a diagnosis of combined rheumatic disorders of mitral, aortic and tricuspid valves.

Key Diagnostic Point:

I08.3 refers to combined rheumatic disorders affecting the mitral, aortic, and tricuspid valves, which are critical components of the heart's anatomy. These disorders typically arise from rheumatic fever, a complication of untreated streptococcal throat infection. Clinically, patients may present with symptoms such as dyspnea, fatigue, palpitations, and signs of heart failure. The disease progression can lead to significant valvular stenosis or regurgitation, resulting in compromised cardiac output and increased workload on the heart. Diagnosis often involves echocardiography to assess valve structure and function, alongside clinical evaluation of symptoms. Other diagnostic considerations include laboratory tests to identify streptococcal infection and inflammatory markers. Management may involve medical therapy, surgical intervention, or valve replacement, depending on the severity of the condition and the specific valves involved.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires comprehensive evaluation of symptoms and imaging studies.
  • Treatment complexity: May involve multi-disciplinary approaches including cardiology and surgery.
  • Documentation requirements: Detailed clinical notes and imaging reports are necessary.
  • Coding specificity: Requires precise coding to differentiate from other rheumatic heart diseases.

Audit Risk Factors

  • Common coding errors: Misidentification of the primary valve affected.
  • Documentation gaps: Incomplete clinical notes regarding symptoms and diagnostic tests.
  • Billing challenges: Potential denials due to lack of supporting documentation for multi-valve involvement.

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

The clinical significance of I08.3 lies in its potential to lead to severe heart failure and increased morbidity if left untreated. Population health impact is notable, as rheumatic heart disease remains prevalent in certain regions, particularly in developing countries. Quality measures focus on early diagnosis and management to prevent complications. Healthcare utilization patterns may reflect increased hospital admissions for heart failure and surgical interventions, highlighting the need for effective preventive strategies and management protocols.

ICD-9 vs ICD-10

The clinical significance of I08.3 lies in its potential to lead to severe heart failure and increased morbidity if left untreated. Population health impact is notable, as rheumatic heart disease remains prevalent in certain regions, particularly in developing countries. Quality measures focus on early diagnosis and management to prevent complications. Healthcare utilization patterns may reflect increased hospital admissions for heart failure and surgical interventions, highlighting the need for effective preventive strategies and management protocols.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of care provided, with potential for higher reimbursement for surgical interventions. Common denials may arise from insufficient documentation of multi-valve involvement or lack of evidence supporting the diagnosis of rheumatic heart disease. Coders should ensure that all relevant clinical details are captured to support the medical necessity of the services rendered.

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 I08.3?

I08.3 encompasses combined rheumatic heart diseases affecting the mitral, aortic, and tricuspid valves, typically resulting from rheumatic fever. It includes conditions such as rheumatic mitral stenosis, aortic regurgitation, and tricuspid regurgitation.

When should I08.3 be used instead of related codes?

I08.3 should be used when there is documented involvement of multiple heart valves due to rheumatic disease, distinguishing it from codes that specify involvement of a single valve.

What documentation supports I08.3?

Documentation must include clinical findings, echocardiographic results showing multi-valve involvement, and evidence of rheumatic fever history or streptococcal infection.