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ICD-10 Guide
ICD-10 CodesI27.83

I27.83

Billable

Eisenmenger's syndrome

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

Code Description

ICD-10 I27.83 is a billable code used to indicate a diagnosis of eisenmenger's syndrome.

Key Diagnostic Point:

Eisenmenger's syndrome is a complex condition characterized by the development of pulmonary arterial hypertension (PAH) due to a long-standing left-to-right shunt, typically resulting from congenital heart defects such as ventricular septal defect (VSD) or atrial septal defect (ASD). Over time, the increased blood flow to the lungs leads to vascular remodeling and elevated pulmonary artery pressures, eventually causing a reversal of the shunt to a right-to-left direction. Clinically, patients may present with symptoms such as cyanosis, exertional dyspnea, fatigue, and signs of right heart failure. The anatomy involved includes the heart's chambers, particularly the right ventricle, and the pulmonary arteries. Disease progression can lead to severe complications, including arrhythmias, thromboembolic events, and decreased exercise tolerance. Diagnostic considerations include echocardiography, cardiac catheterization, and pulmonary function tests to assess the severity of PAH and the underlying structural heart defects. Early recognition and management are crucial to improving outcomes and quality of life for affected individuals.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity: Requires comprehensive evaluation of congenital heart defects and pulmonary pressures.
  • Treatment complexity: Management may involve medications, surgical interventions, and multidisciplinary care.
  • Documentation requirements: Detailed clinical documentation is essential to support diagnosis and treatment plans.
  • Coding specificity: Requires precise coding to differentiate from other forms of pulmonary hypertension.

Audit Risk Factors

  • Common coding errors: Misclassification of pulmonary hypertension types.
  • Documentation gaps: Incomplete records regarding congenital heart defects and their management.
  • Billing challenges: Potential denials due to insufficient evidence of medical necessity for treatments.

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

Pulmonology

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

Eisenmenger's syndrome significantly impacts clinical outcomes and healthcare utilization, as it often leads to severe complications and increased morbidity. The condition is relatively rare but has a profound effect on affected individuals' quality of life. Understanding its epidemiology is crucial for population health management, as early diagnosis and intervention can improve patient outcomes and reduce healthcare costs associated with advanced disease management.

ICD-9 vs ICD-10

Eisenmenger's syndrome significantly impacts clinical outcomes and healthcare utilization, as it often leads to severe complications and increased morbidity. The condition is relatively rare but has a profound effect on affected individuals' quality of life. Understanding its epidemiology is crucial for population health management, as early diagnosis and intervention can improve patient outcomes and reduce healthcare costs associated with advanced disease management.

Reimbursement & Billing Impact

reimbursement. Regular audits and updates to coding practices can help mitigate 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 I27.83?

I27.83 specifically covers Eisenmenger's syndrome, which arises from congenital heart defects leading to pulmonary arterial hypertension. It is characterized by a right-to-left shunt due to elevated pulmonary pressures.

When should I27.83 be used instead of related codes?

I27.83 should be used when the patient has established Eisenmenger's syndrome with a documented right-to-left shunt due to pulmonary hypertension, differentiating it from other types of pulmonary hypertension.

What documentation supports I27.83?

Documentation should include echocardiographic findings, evidence of pulmonary hypertension, details of congenital heart defects, and clinical symptoms consistent with Eisenmenger's syndrome.