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ICD-10 Guide
ICD-10 CodesI35.1

I35.1

Billable

Nonrheumatic aortic (valve) insufficiency

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

Code Description

ICD-10 I35.1 is a billable code used to indicate a diagnosis of nonrheumatic aortic (valve) insufficiency.

Key Diagnostic Point:

Nonrheumatic aortic valve insufficiency is characterized by the inability of the aortic valve to close properly, leading to the backflow of blood from the aorta into the left ventricle during diastole. This condition can result from various etiologies, including degenerative changes, congenital defects, or infective endocarditis. Clinically, patients may present with symptoms such as dyspnea, fatigue, palpitations, and signs of heart failure. The left ventricle compensates initially through hypertrophy, but over time, this can lead to ventricular dilation and decreased cardiac output. Diagnosis typically involves echocardiography, which assesses the severity of regurgitation and the structure of the aortic valve. Additional imaging modalities, such as MRI or CT, may be utilized for further evaluation. Regular monitoring and timely intervention are crucial to manage the progression of the disease and prevent complications such as heart failure or arrhythmias.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical evaluation to confirm
  • Treatment complexity: May involve medical management or surgical intervention
  • Documentation requirements: Detailed clinical notes and imaging results needed
  • Coding specificity: Requires precise documentation of the condition and its severity

Audit Risk Factors

  • Common coding errors: Misclassification of the severity or type of valve insufficiency
  • Documentation gaps: Incomplete clinical notes or lack of imaging reports
  • Billing challenges: Denials due to insufficient documentation or incorrect coding

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 valve insufficiency significantly impacts patient quality of life and can lead to increased healthcare utilization due to hospitalizations for heart failure or surgical interventions. It is essential for population health management, as timely diagnosis and treatment can reduce morbidity and mortality associated with advanced heart disease. Understanding epidemiological trends helps in resource allocation and preventive strategies in cardiovascular care.

ICD-9 vs ICD-10

Nonrheumatic aortic valve insufficiency significantly impacts patient quality of life and can lead to increased healthcare utilization due to hospitalizations for heart failure or surgical interventions. It is essential for population health management, as timely diagnosis and treatment can reduce morbidity and mortality associated with advanced heart disease. Understanding epidemiological trends helps in resource allocation and preventive strategies in cardiovascular care.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the condition and whether surgical intervention is performed. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures. Coders should ensure that all relevant clinical details are captured to support the diagnosis and any associated procedures.

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 I35.1?

I35.1 specifically covers nonrheumatic aortic valve insufficiency, which may arise from degenerative changes, congenital defects, or infective endocarditis, but excludes rheumatic causes.

When should I35.1 be used instead of related codes?

I35.1 should be used when the aortic valve insufficiency is confirmed to be nonrheumatic in nature, differentiating it from rheumatic or other types of valve disorders.

What documentation supports I35.1?

Documentation must include clinical findings, echocardiographic results indicating aortic regurgitation, and any relevant history of heart disease or surgical interventions.