2025 ICD-10-CM code I34.0
(Active) Effective Date: N/A Revision Date: N/A Diseases of the circulatory system - Other forms of heart disease Chapter IX: Diseases of the circulatory system Feed
Nonrheumatic mitral valve insufficiency.
Modifiers may be applicable depending on the circumstances of service and additional procedures performed. Consult current modifier guidelines.
Medical necessity for I34.0 is established when a patient presents with clinical symptoms or diagnostic findings indicative of mitral valve insufficiency.The severity of the condition and its impact on cardiac function justify medical intervention (medications, procedures). Documentation must clearly demonstrate the need for treatment.
Cardiologists and other physicians specializing in cardiovascular care are responsible for diagnosis and management of this condition.This involves evaluating the patient's symptoms, conducting physical examinations, and ordering diagnostic tests such as echocardiograms to assess valve function and severity of insufficiency. Treatment options may include medication, surgical intervention (valve repair or replacement), or other interventions depending on the severity and patient's overall health.
In simple words: This code describes a problem with the mitral valve in the heart.The mitral valve doesn't close tightly enough, causing blood to leak backward, which can affect how well the heart works.
I34.0, Nonrheumatic mitral (valve) insufficiency, encompasses the condition where the mitral valve, located between the left atrium and left ventricle of the heart, does not close properly, leading to backflow (regurgitation) of blood. This is specifically categorized as nonrheumatic, excluding cases caused by rheumatic fever or other inflammatory conditions.The insufficiency can range in severity, impacting cardiac function and potentially leading to various symptoms.
Example 1: A 60-year-old female patient presents with shortness of breath and fatigue. Echocardiography reveals mild mitral regurgitation. The physician documents I34.0 to reflect the diagnosis., A 75-year-old male patient undergoes cardiac catheterization.The cardiologist observes moderate mitral regurgitation during the procedure.The code I34.0 is included in the report., A 45-year-old patient with a history of mitral valve prolapse is monitored for changes in valve function. During a routine checkup, a worsening of mitral regurgitation is noted and I34.0 is used to bill for this clinical encounter.
Detailed patient history including symptoms (e.g., shortness of breath, fatigue, chest pain).Results from echocardiography and any other relevant diagnostic tests.Physician's assessment and diagnosis with justification for I34.0.Treatment plan and any interventions performed.
** Differentiate from rheumatic mitral valve disease (I05.-). Consider using additional codes to specify the severity of the insufficiency and any associated conditions.
- Payment Status: Active
- Specialties:Cardiology
- Place of Service:Office, Hospital (Inpatient and Outpatient), Ambulatory Surgical Center