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ICD-10 Guide
ICD-10 CodesI35.0

I35.0

Billable

Nonrheumatic aortic (valve) stenosis

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

Code Description

ICD-10 I35.0 is a billable code used to indicate a diagnosis of nonrheumatic aortic (valve) stenosis.

Key Diagnostic Point:

Nonrheumatic aortic stenosis is a condition characterized by the narrowing of the aortic valve, which impedes blood flow from the heart into the aorta and subsequently to the rest of the body. This condition often arises from age-related calcific degeneration of the valve, leading to a tri-leaflet valve becoming stiff and less able to open fully. Patients may present with symptoms such as exertional dyspnea, angina, syncope, and heart failure due to the increased workload on the heart. The anatomy involved includes the aortic valve, left ventricle, and aorta, with potential downstream effects on the coronary arteries and systemic circulation. Disease progression can lead to severe left ventricular hypertrophy, heart failure, and increased mortality if left untreated. Diagnostic considerations include echocardiography to assess valve morphology and function, Doppler studies to measure pressure gradients, and cardiac catheterization in certain cases. Regular monitoring and timely intervention, such as valve replacement, are crucial for managing this condition effectively.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and functional assessment
  • Treatment complexity: May involve surgical intervention or catheter-based therapies
  • Documentation requirements: Detailed clinical history and diagnostic imaging results needed
  • Coding specificity: Requires precise coding to differentiate from rheumatic and other types of stenosis

Audit Risk Factors

  • Common coding errors: Misclassification with rheumatic stenosis or other heart conditions
  • Documentation gaps: Incomplete clinical history 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 aortic stenosis significantly impacts clinical outcomes, particularly in older populations, leading to increased healthcare utilization due to hospitalizations for heart failure and surgical interventions. Understanding the epidemiology of this condition is crucial, as it is prevalent in aging demographics, highlighting the need for effective screening and management strategies. Quality measures related to timely intervention and patient outcomes are essential for improving population health.

ICD-9 vs ICD-10

Nonrheumatic aortic stenosis significantly impacts clinical outcomes, particularly in older populations, leading to increased healthcare utilization due to hospitalizations for heart failure and surgical interventions. Understanding the epidemiology of this condition is crucial, as it is prevalent in aging demographics, highlighting the need for effective screening and management strategies. Quality measures related to timely intervention and patient outcomes are essential for improving population health.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the stenosis, the necessity for surgical intervention, and the patient's overall health status. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures. Coders should ensure that all relevant clinical data, including imaging studies and treatment notes, are included in the patient's medical record to support claims effectively.

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 I35.0?

I35.0 covers nonrheumatic aortic stenosis, primarily due to age-related calcific degeneration or congenital anomalies. It does not include rheumatic causes or other types of aortic valve disorders.

When should I35.0 be used instead of related codes?

I35.0 should be used when the aortic stenosis is confirmed to be nonrheumatic in nature, particularly when the etiology is degenerative or congenital, distinguishing it from rheumatic or other causes.

What documentation supports I35.0?

Documentation should include a detailed clinical assessment, echocardiographic findings indicating aortic stenosis, and any relevant history of valve disease. Imaging reports and treatment plans are also essential.