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ICD-10 Guide
ICD-10 CodesI34.0

I34.0

Billable

Nonrheumatic mitral (valve) insufficiency

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

Code Description

ICD-10 I34.0 is a billable code used to indicate a diagnosis of nonrheumatic mitral (valve) insufficiency.

Key Diagnostic Point:

Nonrheumatic mitral valve insufficiency is a condition characterized by the inability of the mitral valve to close properly, leading to the backflow of blood from the left ventricle into the left atrium during systole. This condition can result from various etiologies, including degenerative changes, ischemic heart disease, or congenital defects. Clinically, patients may present with symptoms such as dyspnea, fatigue, palpitations, and signs of heart failure. The anatomy involved includes the mitral valve, which consists of two leaflets, chordae tendineae, and papillary muscles that maintain valve function. Disease progression can lead to left atrial enlargement, pulmonary hypertension, and ultimately heart failure if left untreated. Diagnostic considerations include echocardiography, which is the primary imaging modality used to assess mitral valve structure and function, along with Doppler studies to evaluate the severity of regurgitation. Other diagnostic tools may include chest X-rays and cardiac MRI in complex cases.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires echocardiographic evaluation and clinical correlation.
  • Treatment complexity: Management may involve medical therapy or surgical intervention, depending on severity.
  • Documentation requirements: Detailed clinical notes and imaging reports are essential.
  • Coding specificity: Requires precise coding to differentiate from rheumatic and other types of mitral valve disorders.

Audit Risk Factors

  • Common coding errors: Misclassification with rheumatic conditions or other valvular disorders.
  • Documentation gaps: Incomplete clinical notes or lack of imaging reports.
  • Billing challenges: Potential denials if documentation does not support the severity of the condition.

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

Cardiothoracic Surgery

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

Nonrheumatic mitral valve insufficiency has significant clinical implications, contributing to heart failure and increased healthcare utilization. It affects a considerable portion of the population, particularly older adults, and can lead to substantial morbidity if not managed appropriately. Quality measures related to this condition focus on timely diagnosis and effective management strategies to improve patient outcomes and reduce hospitalizations.

ICD-9 vs ICD-10

Nonrheumatic mitral valve insufficiency has significant clinical implications, contributing to heart failure and increased healthcare utilization. It affects a considerable portion of the population, particularly older adults, and can lead to substantial morbidity if not managed appropriately. Quality measures related to this condition focus on timely diagnosis and effective management strategies to improve patient outcomes and reduce hospitalizations.

Reimbursement & Billing Impact

Reimbursement considerations include the need for pre-authorization for surgical interventions and ensuring that all diagnostic tests are well-documented to support the medical necessity of the services provided. Common denials may arise from insufficient documentation or failure to demonstrate the necessity of procedures. Coding best practices include using the most specific code available and ensuring that all relevant clinical information is included in the patient's medical record.

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 I34.0?

I34.0 covers nonrheumatic mitral valve insufficiency, which may arise from degenerative changes, ischemic heart disease, or congenital anomalies. It does not include rheumatic causes or other valvular insufficiencies.

When should I34.0 be used instead of related codes?

I34.0 should be used when the mitral valve insufficiency is confirmed to be nonrheumatic in nature, differentiating it from I34.1, which is specifically for rheumatic causes.

What documentation supports I34.0?

Documentation should include a detailed clinical history, physical examination findings, echocardiographic reports demonstrating mitral valve insufficiency, and any relevant lab results that support the diagnosis.