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ICD-10 Guide
ICD-10 CodesI34.1

I34.1

Billable

Nonrheumatic mitral (valve) prolapse

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

Code Description

ICD-10 I34.1 is a billable code used to indicate a diagnosis of nonrheumatic mitral (valve) prolapse.

Key Diagnostic Point:

Nonrheumatic mitral valve prolapse (MVP) is a condition characterized by the abnormal displacement of one or both leaflets of the mitral valve into the left atrium during systole. This condition can lead to mitral regurgitation, where blood leaks backward into the left atrium, potentially causing symptoms such as palpitations, chest pain, and fatigue. MVP is often asymptomatic and may be discovered incidentally during echocardiography. The mitral valve is located between the left atrium and left ventricle, and its proper function is crucial for maintaining efficient blood flow through the heart. Disease progression can vary; while many individuals remain asymptomatic, others may develop complications such as arrhythmias or heart failure. Diagnostic considerations include echocardiography, which can visualize the valve's structure and function, and Holter monitoring for arrhythmias. A thorough clinical evaluation is essential to differentiate MVP from other cardiac conditions, particularly in patients presenting with atypical symptoms.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: MVP can be asymptomatic and may require advanced imaging for diagnosis.
  • Treatment complexity: Management may include lifestyle modifications, monitoring, or surgical intervention in severe cases.
  • Documentation requirements: Accurate documentation of symptoms, diagnostic tests, and treatment plans is crucial.
  • Coding specificity: Requires precise coding to differentiate from other mitral valve disorders.

Audit Risk Factors

  • Common coding errors: Misclassification of MVP as rheumatic when it is nonrheumatic.
  • Documentation gaps: Incomplete records regarding symptoms or diagnostic tests.
  • Billing challenges: Potential denials if documentation does not clearly support the diagnosis.

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

Primary Care

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

Nonrheumatic mitral valve prolapse has significant clinical implications, as it can affect a substantial portion of the population, particularly women. The condition can lead to increased healthcare utilization due to associated symptoms and complications, such as arrhythmias and heart failure. Quality measures may include monitoring for appropriate follow-up care and management of symptoms. Understanding the epidemiological aspects of MVP can help healthcare providers better address the needs of affected populations.

ICD-9 vs ICD-10

Nonrheumatic mitral valve prolapse has significant clinical implications, as it can affect a substantial portion of the population, particularly women. The condition can lead to increased healthcare utilization due to associated symptoms and complications, such as arrhythmias and heart failure. Quality measures may include monitoring for appropriate follow-up care and management of symptoms. Understanding the epidemiological aspects of MVP can help healthcare providers better address the needs of affected populations.

Reimbursement & Billing Impact

Reimbursement considerations include the need for thorough clinical documentation that supports the diagnosis and any treatments provided. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for diagnostic tests. Best practices include ensuring that all relevant clinical findings are recorded and that the coding accurately reflects the patient's condition and treatment plan.

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 I34.1?

I34.1 specifically covers nonrheumatic mitral valve prolapse, which may include variations in severity and associated mitral regurgitation but excludes rheumatic causes.

When should I34.1 be used instead of related codes?

I34.1 should be used when the mitral valve prolapse is confirmed to be nonrheumatic, particularly when there is no history of rheumatic fever or associated rheumatic heart disease.

What documentation supports I34.1?

Documentation should include clinical findings, echocardiographic results confirming the diagnosis of nonrheumatic mitral valve prolapse, and any symptoms experienced by the patient.