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ICDxICD-10 Medical Coding

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v1.0.0
ICD-10 Guide
ICD-10 CodesR01.0

R01.0

Benign and innocent cardiac murmurs

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

Code Description

ICD-10 R01.0 is a billable code used to indicate a diagnosis of benign and innocent cardiac murmurs.

Key Diagnostic Point:

Benign and innocent cardiac murmurs are typically characterized by sounds produced by blood flow through the heart and its valves that are not associated with any structural heart disease. These murmurs are often detected during routine physical examinations and are common in children and young adults. They are usually classified as systolic murmurs and are often described as soft, blowing, or musical in quality. The presence of these murmurs is generally considered normal and does not require further investigation unless accompanied by other concerning symptoms. Common causes include increased blood flow states such as fever, anemia, or hyperthyroidism. The diagnostic approach involves a thorough clinical history and physical examination, often supplemented by echocardiography if there are any atypical features or associated symptoms. It is crucial to differentiate benign murmurs from pathological ones, which may indicate underlying heart conditions.

Code Complexity Analysis

Complexity Rating: Low

Low Complexity

Complexity Factors

  • Commonly encountered in routine exams
  • Typically requires minimal additional testing
  • Clear differentiation from pathological murmurs
  • Standard documentation practices

Audit Risk Factors

  • Inadequate documentation of clinical findings
  • Failure to specify if the murmur is innocent or pathological
  • Misuse of related codes for non-specific murmurs
  • Lack of follow-up documentation if symptoms change

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Document the nature of the murmur, any associated symptoms, and the patient's history.

Common Clinical Scenarios

Routine check-ups where murmurs are detected incidentally.

Billing Considerations

Ensure to note any changes in the murmur or new symptoms that may arise.

Emergency Medicine

Documentation Requirements

Thorough documentation of the patient's presenting symptoms and any acute findings.

Common Clinical Scenarios

Patients presenting with chest pain or palpitations where a murmur is detected.

Billing Considerations

Consider the urgency of ruling out serious conditions, even if the murmur appears benign.

Coding Guidelines

Inclusion Criteria

Use R01.0 When
  • Follow the official ICD
  • CM coding guidelines, ensuring that the diagnosis is supported by clinical findings and that the murmur is classified as benign

Exclusion Criteria

Do NOT use R01.0 When
No specific exclusions found.

Related CPT Codes

93000CPT Code

Electrocardiogram, ECG

Clinical Scenario

When a murmur is detected during a physical exam and further cardiac evaluation is warranted.

Documentation Requirements

Document the reason for the ECG and any findings.

Specialty Considerations

Ensure that the ECG is interpreted in the context of the murmur.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of benign murmurs, improving the accuracy of data collection and reimbursement processes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of benign murmurs, improving the accuracy of data collection and reimbursement processes.

Reimbursement & Billing Impact

reimbursement processes.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the difference between a benign and a pathological murmur?

A benign murmur is typically soft, does not indicate heart disease, and is often found in healthy individuals, while a pathological murmur suggests underlying heart conditions and may require further investigation.