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ICD-10 Guide
ICD-10 CodesQ23.1

Q23.1

Billable

Congenital insufficiency of aortic valve

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 Q23.1 is a billable code used to indicate a diagnosis of congenital insufficiency of aortic valve.

Key Diagnostic Point:

Congenital insufficiency of the aortic valve is a condition characterized by the improper closure of the aortic valve, leading to regurgitation of blood from the aorta back into the left ventricle during diastole. This condition can result from various congenital heart defects, including aortic valve malformations, which may be isolated or associated with other cardiac anomalies such as coarctation of the aorta or septal defects. Patients may present with symptoms such as fatigue, shortness of breath, and heart murmur. Diagnosis typically involves echocardiography, which can assess the structure and function of the aortic valve and the left ventricle. Management may include medical therapy or surgical intervention, depending on the severity of the insufficiency and associated complications. Early detection and treatment are crucial to prevent long-term sequelae such as heart failure or arrhythmias.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of the condition
  • Need for detailed echocardiographic findings
  • Potential association with other congenital heart defects
  • Differentiation from acquired aortic insufficiency

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to specify associated congenital anomalies
  • Misclassification of the severity of insufficiency
  • Inconsistent use of diagnostic imaging reports

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Pediatric documentation should include growth parameters, developmental milestones, and specific symptoms related to cardiac function.

Common Clinical Scenarios

Common scenarios include routine evaluations for congenital heart defects, pre-operative assessments, and post-operative follow-ups.

Billing Considerations

Consideration of age-related physiological changes in heart function and the impact of congenital defects on growth and development.

Genetics

Documentation Requirements

Genetic documentation should include family history of congenital heart defects and any syndromic associations.

Common Clinical Scenarios

Genetic counseling for families with a history of congenital heart disease and evaluation for syndromic conditions.

Billing Considerations

Awareness of chromosomal abnormalities that may be associated with congenital heart defects, such as Down syndrome.

Coding Guidelines

Inclusion Criteria

Use Q23.1 When
  • Follow official ICD
  • CM guidelines for coding congenital conditions, ensuring specificity in documentation and adherence to coding conventions for congenital heart defects

Exclusion Criteria

Do NOT use Q23.1 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

93306CPT Code

Echocardiography, transthoracic, real-time with interpretation

Clinical Scenario

Used for initial assessment and monitoring of congenital aortic valve insufficiency.

Documentation Requirements

Documentation of indications for echocardiography and findings.

Specialty Considerations

Pediatric cardiology may require additional details on growth and development.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding congenital conditions, improving the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding congenital conditions, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Coding for Congenital Heart Disease

Coding & Billing References

  • •
    American Academy of Pediatrics - Coding for Congenital Heart Disease

Frequently Asked Questions

What are the common symptoms of congenital aortic valve insufficiency?

Common symptoms include fatigue, shortness of breath, palpitations, and a characteristic heart murmur. Symptoms may vary based on the severity of the condition and the age of the patient.