2025 ICD-10-CM code I36
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Diseases of the circulatory system - Other forms of heart disease Diseases of the circulatory system (I00-I99) Feed
Nonrheumatic tricuspid valve disorders.
Modifiers may be applicable depending on the circumstances of the service provided, such as the location, type of procedure or the complexity of the care.Always consult the applicable guidelines.
Medical necessity for procedures related to this code is established through clinical evidence demonstrating symptoms related to tricuspid valve dysfunction, the severity of the valve disorder (based on imaging and other diagnostic findings), and the potential for improved cardiovascular function and quality of life with treatment (medication, intervention, or surgery).Justification should address the specific clinical scenario, ruling out other potential causes and demonstrating a correlation between symptoms and tricuspid valve pathology.
The clinical responsibility for this code lies with the cardiologist or other physician managing the patient's cardiac health.This involves a thorough evaluation of the patient's symptoms, history, and physical examination, potentially including echocardiography, cardiac catheterization, and other diagnostic tests to determine the nature and severity of the tricuspid valve disorder.Treatment plans may include medication, interventional cardiology procedures, or surgery depending on the specific condition and the patient's overall health.
In simple words: This code describes problems with the tricuspid heart valve that aren't caused by rheumatic fever (a type of heart disease).The tricuspid valve is one of the four valves in the heart, and this code covers various issues that affect how well it works.
This ICD-10-CM code encompasses disorders affecting the tricuspid valve that are not caused by rheumatic fever.It includes various conditions impacting the valve's structure and function, excluding those specifically attributed to rheumatic heart disease or congenital anomalies.The code may require further specification with additional digits to indicate the specific type of tricuspid valve disorder.
Example 1: A 65-year-old patient presents with symptoms of right-sided heart failure, including edema and shortness of breath.Echocardiography reveals tricuspid regurgitation due to annular dilation, not related to rheumatic fever.The physician codes this as I36., A 40-year-old patient with a history of endocarditis undergoes cardiac catheterization, revealing significant tricuspid valve stenosis.The infection is resolved, and the stenosis is determined to be nonrheumatic in origin. The physician codes I36 to reflect the nonrheumatic nature of the valve disorder. , A 70-year-old patient with a history of coronary artery disease is evaluated for worsening dyspnea.Cardiac imaging demonstrates severe tricuspid regurgitation due to right ventricular dysfunction.Further investigation rules out rheumatic heart disease or congenital etiology. I36 is used to accurately reflect the diagnosis.
Comprehensive documentation is required to support the use of this code. This should include the patient's history, physical examination findings, detailed echocardiogram report (including valvular morphology, function, and severity of any regurgitation or stenosis), and any other relevant diagnostic testing (e.g., cardiac catheterization).The documentation should explicitly state the absence of rheumatic heart disease and other possible etiologies for the tricuspid valve disorder.
** Further specification of the type of tricuspid valve disorder (e.g., regurgitation, stenosis) may be required using additional digits, depending on the clinical situation.Always cross-reference with other relevant codes to ensure complete and accurate clinical representation.
- Payment Status: Active
- Modifier TC rule: The application of a Technical Component (TC) modifier is not generally applicable to this diagnostic code, as it is used for diagnosis rather than procedures.
- Specialties:Cardiology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office