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ICD-10 Guide
ICD-10 CodesI37.9

I37.9

Billable

Nonrheumatic pulmonary valve disorder, unspecified

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

Code Description

ICD-10 I37.9 is a billable code used to indicate a diagnosis of nonrheumatic pulmonary valve disorder, unspecified.

Key Diagnostic Point:

Nonrheumatic pulmonary valve disorder, unspecified, refers to a range of conditions affecting the pulmonary valve that are not caused by rheumatic fever. The pulmonary valve is located between the right ventricle and the pulmonary artery, regulating blood flow from the heart to the lungs. Clinical presentation may include symptoms such as dyspnea, fatigue, and cyanosis, which can arise from obstructive or regurgitant lesions. Disease progression can vary, with some patients remaining asymptomatic for years while others may develop significant heart failure or arrhythmias. Diagnostic considerations include echocardiography, which is the primary imaging modality for assessing valve structure and function, as well as cardiac MRI or CT for detailed anatomical evaluation. The absence of specific etiology in I37.9 necessitates thorough clinical assessment to rule out other underlying conditions, including congenital heart defects or degenerative valve disease.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires comprehensive evaluation to determine the underlying cause and severity of the valve disorder.
  • Treatment complexity: Management may involve medical therapy, monitoring, or surgical intervention, depending on the severity.
  • Documentation requirements: Detailed clinical documentation is necessary to support the diagnosis and treatment plan.
  • Coding specificity: While I37.9 is a broad code, accurate coding may require additional specificity based on clinical findings.

Audit Risk Factors

  • Common coding errors: Misapplication of related codes or failure to document the specific nature of the disorder.
  • Documentation gaps: Incomplete clinical notes that do not clearly outline the diagnosis or treatment plan.
  • Billing challenges: Potential for denials if documentation does not support the medical necessity of services rendered.

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

Pulmonology

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 disorders can significantly impact patient quality of life and healthcare utilization. Early diagnosis and appropriate management are crucial to prevent complications such as heart failure or arrhythmias. Understanding the epidemiology of these conditions helps in developing targeted interventions and quality measures aimed at improving patient outcomes and reducing healthcare costs.

ICD-9 vs ICD-10

Nonrheumatic pulmonary valve disorders can significantly impact patient quality of life and healthcare utilization. Early diagnosis and appropriate management are crucial to prevent complications such as heart failure or arrhythmias. Understanding the epidemiology of these conditions helps in developing targeted interventions and quality measures aimed at improving patient outcomes and reducing healthcare costs.

Reimbursement & Billing Impact

reimbursement and minimize audit risks.

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 I37.9?

I37.9 encompasses various nonrheumatic pulmonary valve disorders, including but not limited to pulmonary valve stenosis, insufficiency, and other unspecified abnormalities of the pulmonary valve that are not attributable to rheumatic disease.

When should I37.9 be used instead of related codes?

I37.9 should be used when the specific type of nonrheumatic pulmonary valve disorder is not clearly defined or documented. If a more specific diagnosis is available, such as I37.0 or I37.1, those codes should be utilized.

What documentation supports I37.9?

Documentation should include a detailed clinical history, physical examination findings, results from echocardiography or other imaging studies, and any relevant laboratory tests that support the diagnosis of a nonrheumatic pulmonary valve disorder.