2025 ICD-10-CM code I05.1
(Active) Effective Date: N/A Chronic rheumatic heart diseases - Rheumatic mitral valve diseases IX Diseases of the circulatory system Feed
Rheumatic mitral insufficiency. This condition involves a leak in the mitral valve of the heart caused by rheumatic fever.
Medical necessity for services related to I05.1 is established by the presence of symptoms and signs of mitral regurgitation caused by rheumatic heart disease. This may include shortness of breath, fatigue, heart murmurs, and evidence of cardiac dysfunction on imaging studies.
Diagnosing and managing rheumatic mitral insufficiency typically falls under the purview of cardiologists. They are responsible for evaluating the severity of the condition, determining appropriate treatment strategies, and monitoring patient progress.
In simple words: This code indicates a leaky heart valve (mitral valve) due to rheumatic fever.The mitral valve separates two chambers on the left side of your heart. When it leaks, blood can flow backward, making the heart work less efficiently.
Rheumatic mitral insufficiency, rheumatic mitral incompetence, rheumatic mitral regurgitation. Excludes1: mitral insufficiency not specified as rheumatic (I34.0)
Example 1: A 50-year-old patient with a history of rheumatic fever presents with shortness of breath and fatigue. An echocardiogram reveals mitral regurgitation. The physician documents rheumatic mitral insufficiency (I05.1)., A 30-year-old patient is diagnosed with mitral valve prolapse and a heart murmur. Further investigation reveals a history of untreated strep throat infections, suggesting rheumatic fever as the underlying cause of the valve dysfunction. The diagnosis is coded as I05.1., During a routine physical exam, a 60-year-old patient is found to have a heart murmur.An echocardiogram confirms mitral regurgitation, and the patient's medical history indicates a prior diagnosis of rheumatic fever. The diagnosis is coded as rheumatic mitral insufficiency (I05.1).
Documentation for I05.1 should include evidence of rheumatic fever, such as past medical history, positive strep tests, or other supporting documentation. Echocardiogram or other imaging findings demonstrating mitral insufficiency should also be included.
- Payment Status: Active
- Specialties:Cardiology
- Place of Service:Inpatient Hospital, On Campus-Outpatient Hospital, Office, Independent Clinic