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ICD-10 Guide
ICD-10 CodesI36.0

I36.0

Billable

Nonrheumatic tricuspid (valve) stenosis

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

Code Description

ICD-10 I36.0 is a billable code used to indicate a diagnosis of nonrheumatic tricuspid (valve) stenosis.

Key Diagnostic Point:

Nonrheumatic tricuspid stenosis is a condition characterized by the narrowing of the tricuspid valve, which impedes blood flow from the right atrium to the right ventricle. This condition can lead to increased pressure in the right atrium, resulting in symptoms such as fatigue, palpitations, and peripheral edema. The tricuspid valve is located between the right atrium and right ventricle, and its dysfunction can be caused by various factors, including congenital defects, degenerative changes, or other heart conditions. Disease progression may lead to right-sided heart failure if left untreated. Diagnosis typically involves echocardiography, which can assess valve morphology and hemodynamics. Other imaging modalities, such as MRI or CT, may be utilized for further evaluation. Clinicians must consider the patient's history, physical examination findings, and the presence of associated conditions, such as atrial fibrillation or pulmonary hypertension, when diagnosing and managing tricuspid stenosis.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires echocardiographic assessment and may involve differential diagnosis with other valvular heart diseases.
  • Treatment complexity: Management may include medical therapy or surgical intervention, depending on severity.
  • Documentation requirements: Detailed clinical documentation is necessary to support the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to differentiate from rheumatic and other types of tricuspid stenosis.

Audit Risk Factors

  • Common coding errors: Misclassification with rheumatic tricuspid stenosis (I35.0).
  • Documentation gaps: Incomplete clinical history or lack of imaging reports.
  • Billing challenges: Potential denials due to insufficient documentation supporting 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

Internal Medicine

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 tricuspid stenosis can significantly impact patient quality of life and may lead to serious complications such as heart failure if not managed appropriately. Understanding the epidemiology of this condition is crucial, as it may be underdiagnosed in certain populations. Effective management can improve healthcare utilization patterns and contribute to better population health outcomes.

ICD-9 vs ICD-10

Nonrheumatic tricuspid stenosis can significantly impact patient quality of life and may lead to serious complications such as heart failure if not managed appropriately. Understanding the epidemiology of this condition is crucial, as it may be underdiagnosed in certain populations. Effective management can improve healthcare utilization patterns and contribute to better population health outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the case and the necessity of procedures performed. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for interventions. Coders should ensure that all relevant clinical information is included in the medical record 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 I36.0?

I36.0 specifically covers nonrheumatic tricuspid stenosis, which may arise from congenital anomalies, degenerative changes, or other heart conditions, excluding rheumatic causes.

When should I36.0 be used instead of related codes?

I36.0 should be used when the tricuspid stenosis is confirmed to be nonrheumatic in nature. If the stenosis is due to rheumatic heart disease, then I35.0 should be used.

What documentation supports I36.0?

Documentation should include echocardiographic findings, clinical symptoms, and any relevant history of heart disease. Detailed notes on the patient's functional status and treatment plan are also essential.