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ICD-10 Guide
ICD-10 CodesI38

I38

Billable

Endocarditis, valve unspecified

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

Code Description

ICD-10 I38 is a billable code used to indicate a diagnosis of endocarditis, valve unspecified.

Key Diagnostic Point:

Endocarditis, valve unspecified, refers to the inflammation of the inner lining of the heart chambers and valves, which can occur due to various infectious agents, including bacteria, fungi, or other pathogens. Clinically, patients may present with symptoms such as fever, chills, fatigue, and heart murmurs. The anatomy involved primarily includes the heart valves, which may be affected by vegetations—masses of platelets, fibrin, and microorganisms. Disease progression can lead to severe complications, including valve dysfunction, heart failure, and systemic embolization. Diagnostic considerations include blood cultures, echocardiography, and clinical criteria such as the Duke criteria, which help differentiate between infective endocarditis and other cardiac conditions. Early diagnosis and treatment are crucial to prevent adverse outcomes, making awareness of this condition essential for healthcare providers.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough evaluation and differential diagnosis.
  • Treatment complexity: May involve prolonged antibiotic therapy or surgical intervention.
  • Documentation requirements: Detailed clinical notes and diagnostic evidence are necessary.
  • Coding specificity: Requires accurate identification of the type of endocarditis and associated conditions.

Audit Risk Factors

  • Common coding errors: Misidentifying the type of endocarditis or failing to specify the valve involved.
  • Documentation gaps: Incomplete clinical notes that do not support the diagnosis.
  • Billing challenges: Potential for denials if documentation does not clearly justify the use of I38.

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

Infectious Disease

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 CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Endocarditis has significant clinical implications, as it can lead to severe complications such as heart failure and systemic emboli. The population health impact is notable, particularly among individuals with pre-existing heart conditions or those who are immunocompromised. Quality measures related to endocarditis management focus on timely diagnosis and appropriate antibiotic therapy, which can improve patient outcomes and reduce healthcare utilization. Epidemiologically, the incidence of endocarditis varies, but it remains a critical concern in cardiovascular health.

ICD-9 vs ICD-10

Endocarditis has significant clinical implications, as it can lead to severe complications such as heart failure and systemic emboli. The population health impact is notable, particularly among individuals with pre-existing heart conditions or those who are immunocompromised. Quality measures related to endocarditis management focus on timely diagnosis and appropriate antibiotic therapy, which can improve patient outcomes and reduce healthcare utilization. Epidemiologically, the incidence of endocarditis varies, but it remains a critical concern in cardiovascular health.

Reimbursement & Billing Impact

Reimbursement considerations include the need for detailed clinical notes that justify the use of I38. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for the services rendered. Best practices include ensuring that all clinical findings, diagnostic tests, and treatment plans are clearly documented and aligned with the coding guidelines to support the claim.

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 I38?

I38 covers cases of endocarditis where the specific valve affected is not documented. This includes both acute and chronic forms of endocarditis that do not specify the valve involved.

When should I38 be used instead of related codes?

I38 should be used when the clinical documentation indicates endocarditis but does not specify which valve is affected. If the valve is identified, codes such as I33 or I35 should be considered.

What documentation supports I38?

Documentation should include clinical findings such as fever, heart murmur, and positive blood cultures, as well as imaging studies like echocardiograms that support the diagnosis of endocarditis.