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ICD-10 Guide
ICD-10 CodesI37.0

I37.0

Billable

Nonrheumatic pulmonary valve stenosis

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

Code Description

ICD-10 I37.0 is a billable code used to indicate a diagnosis of nonrheumatic pulmonary valve stenosis.

Key Diagnostic Point:

Nonrheumatic pulmonary valve stenosis is a condition characterized by the narrowing of the pulmonary valve, which impedes blood flow from the right ventricle to the pulmonary artery. This condition can be congenital or acquired, with congenital cases being more common. Clinically, patients may present with symptoms such as exertional dyspnea, fatigue, and syncope, particularly during physical activity. The anatomy involved includes the right ventricle, pulmonary valve, and pulmonary artery. Over time, the increased pressure in the right ventricle can lead to right ventricular hypertrophy and potentially heart failure if left untreated. Diagnostic considerations include echocardiography, which is the primary tool for assessing the severity of stenosis, and cardiac catheterization in more complex cases. The progression of the disease can vary, with some patients remaining asymptomatic for years, while others may require surgical intervention, such as balloon valvuloplasty or valve replacement, depending on the severity of the stenosis and associated symptoms.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging studies and possibly invasive procedures for accurate assessment.
  • Treatment complexity: Management may involve surgical intervention or ongoing monitoring.
  • Documentation requirements: Detailed clinical notes and imaging reports are necessary for accurate coding.
  • Coding specificity: Requires precise coding to differentiate from other types of valve stenosis.

Audit Risk Factors

  • Common coding errors: Misclassification with rheumatic causes or other valve disorders.
  • Documentation gaps: Incomplete clinical notes regarding symptoms and diagnostic tests.
  • 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

Pediatrics

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 pulmonary valve stenosis can significantly impact patient quality of life and healthcare utilization, particularly in pediatric populations where congenital cases are more prevalent. Early diagnosis and appropriate management are crucial to prevent complications such as right heart failure. Understanding the epidemiology of this condition helps inform public health strategies and resource allocation for cardiac care.

ICD-9 vs ICD-10

Nonrheumatic pulmonary valve stenosis can significantly impact patient quality of life and healthcare utilization, particularly in pediatric populations where congenital cases are more prevalent. Early diagnosis and appropriate management are crucial to prevent complications such as right heart failure. Understanding the epidemiology of this condition helps inform public health strategies and resource allocation for cardiac care.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the condition and the necessity for procedures such as echocardiography or surgical interventions. Common denials may occur if documentation does not clearly establish the diagnosis or if the procedure is deemed not medically necessary. Best practices include ensuring all clinical notes are complete and that the coding accurately reflects the patient's condition and treatment.

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 I37.0?

I37.0 specifically covers nonrheumatic pulmonary valve stenosis, which may be congenital or acquired, and does not include stenosis due to rheumatic heart disease.

When should I37.0 be used instead of related codes?

I37.0 should be used when the pulmonary valve stenosis is confirmed to be nonrheumatic, differentiating it from rheumatic causes or other types of valve stenosis.

What documentation supports I37.0?

Documentation should include clinical findings, echocardiographic results, and any relevant history of congenital heart defects or previous interventions.