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v1.0.0
ICD-10 Guide
ICD-10 CodesQ23.3

Q23.3

Billable

Congenital mitral insufficiency

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

Code Description

ICD-10 Q23.3 is a billable code used to indicate a diagnosis of congenital mitral insufficiency.

Key Diagnostic Point:

Congenital mitral insufficiency is a condition characterized by the improper closure of the mitral valve, leading to the backflow of blood from the left ventricle into the left atrium during systole. This condition can arise from various congenital malformations, including mitral valve dysplasia, which may involve abnormal valve structure or function. Congenital mitral insufficiency can lead to volume overload of the left atrium and subsequent heart failure if not diagnosed and managed appropriately. Symptoms may include respiratory distress, failure to thrive, and signs of heart failure in infants. Diagnosis typically involves echocardiography, which can visualize the mitral valve's structure and function, and assess the severity of the insufficiency. Management may include medical therapy, surgical intervention, or monitoring, depending on the severity of the condition and the presence of associated congenital heart defects such as atrial septal defects or ventricular septal defects. Early detection and intervention are crucial to improving outcomes in affected children.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in clinical presentation and severity of the condition.
  • Need for detailed echocardiographic findings for accurate coding.
  • Potential for associated congenital heart defects complicating the diagnosis.
  • Documentation of symptoms and management strategies required for coding.

Audit Risk Factors

  • Inadequate documentation of echocardiographic findings.
  • Failure to document associated congenital anomalies.
  • Misclassification of congenital versus acquired conditions.
  • Lack of clarity in the severity of the insufficiency.

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Pediatric documentation must include growth parameters, developmental milestones, and specific symptoms related to heart failure.

Common Clinical Scenarios

Common scenarios include infants presenting with failure to thrive, respiratory distress, or heart murmurs detected during routine examinations.

Billing Considerations

Coders should be aware of the need for comprehensive documentation of associated congenital heart defects and their management.

Genetics

Documentation Requirements

Genetic documentation should include family history, genetic testing results, and any syndromic associations with congenital heart defects.

Common Clinical Scenarios

Scenarios may involve genetic counseling for families with a history of congenital heart defects or syndromes associated with mitral insufficiency.

Billing Considerations

Consideration of chromosomal abnormalities that may predispose to congenital heart defects is essential for accurate coding.

Coding Guidelines

Inclusion Criteria

Use Q23.3 When
  • Follow official ICD
  • CM guidelines for coding congenital malformations, ensuring accurate documentation of the condition's severity and any associated anomalies

Exclusion Criteria

Do NOT use Q23.3 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

93306CPT Code

Echocardiography, transthoracic, real-time with interpretation and report

Clinical Scenario

Used to assess the severity of congenital mitral insufficiency.

Documentation Requirements

Echocardiographic findings must be documented clearly.

Specialty Considerations

Pediatric cardiology may require specific echocardiographic views.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of congenital heart defects, including congenital mitral insufficiency, improving the granularity of data for research and treatment outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital heart defects, including congenital mitral insufficiency, improving the granularity of data for research and treatment outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of congenital heart defects, including congenital mitral insufficiency, improving the granularity of data for research and treatment outcomes.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Congenital Heart Disease

Coding & Billing References

  • •
    American Academy of Pediatrics - Congenital Heart Disease

Frequently Asked Questions

What are the common symptoms of congenital mitral insufficiency?

Common symptoms include respiratory distress, failure to thrive, and signs of heart failure such as tachypnea and poor feeding in infants.