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ICD-10 Guide
ICD-10 CodesI35.2

I35.2

Billable

Nonrheumatic aortic (valve) stenosis with insufficiency

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

Code Description

ICD-10 I35.2 is a billable code used to indicate a diagnosis of nonrheumatic aortic (valve) stenosis with insufficiency.

Key Diagnostic Point:

Nonrheumatic aortic stenosis with insufficiency is a condition characterized by the narrowing of the aortic valve, which impedes blood flow from the heart to the aorta, leading to increased pressure within the heart. This condition often results from age-related calcific degeneration of the valve, congenital defects, or other degenerative processes. Clinically, patients may present with symptoms such as exertional dyspnea, fatigue, angina, and syncope. The anatomy involved primarily includes the aortic valve, left ventricle, and aorta. Disease progression can lead to left ventricular hypertrophy, heart failure, and ultimately, increased morbidity and mortality if left untreated. Diagnostic considerations include echocardiography to assess valve morphology and function, Doppler studies to evaluate blood flow, and potentially cardiac catheterization for further assessment of hemodynamics. 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 clinical evaluation to confirm diagnosis.
  • Treatment complexity: May involve surgical intervention or catheter-based procedures.
  • Documentation requirements: Detailed clinical notes and imaging reports are necessary.
  • Coding specificity: Requires precise coding to differentiate from other types of aortic stenosis.

Audit Risk Factors

  • Common coding errors: Misclassification of stenosis type or severity.
  • Documentation gaps: Incomplete clinical notes regarding symptoms or diagnostic findings.
  • Billing challenges: Potential denials due to lack of supporting documentation for 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

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

The clinical significance of I35.2 is profound, as untreated aortic stenosis with insufficiency can lead to severe heart failure and increased mortality. Population health impact is notable, particularly in aging populations where degenerative heart conditions are prevalent. Quality measures focus on timely diagnosis and intervention, which can significantly improve patient outcomes. Healthcare utilization patterns indicate a need for regular monitoring and potential surgical intervention, highlighting the importance of early detection and management in reducing the burden of cardiovascular diseases.

ICD-9 vs ICD-10

The clinical significance of I35.2 is profound, as untreated aortic stenosis with insufficiency can lead to severe heart failure and increased mortality. Population health impact is notable, particularly in aging populations where degenerative heart conditions are prevalent. Quality measures focus on timely diagnosis and intervention, which can significantly improve patient outcomes. Healthcare utilization patterns indicate a need for regular monitoring and potential surgical intervention, highlighting the importance of early detection and management in reducing the burden of cardiovascular diseases.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the case and the necessity for surgical intervention. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures related to the condition. Best practices include ensuring all clinical notes are thorough and that imaging studies are clearly linked to the diagnosis.

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 I35.2?

I35.2 covers nonrheumatic aortic stenosis accompanied by aortic insufficiency, which may arise from degenerative changes, congenital defects, or other non-inflammatory causes affecting the aortic valve.

When should I35.2 be used instead of related codes?

I35.2 should be used when there is clear evidence of both aortic stenosis and insufficiency. If only stenosis is present without insufficiency, I35.0 should be used instead.

What documentation supports I35.2?

Documentation should include echocardiographic findings indicating both stenosis and insufficiency, clinical symptoms, and any relevant history of cardiovascular disease.