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2025 ICD-10-CM code I38

Endocarditis, valve unspecified. Includes: endocarditis (chronic) NOS, valvular incompetence NOS, valvular insufficiency NOS, valvular regurgitation NOS, valvular stenosis NOS, valvulitis (chronic) NOS. Excludes1: congenital insufficiency of cardiac valve NOS (Q24.8), congenital stenosis of cardiac valve NOS (Q24.8), endocardial fibroelastosis (I42.4), endocarditis specified as rheumatic (I09.1)

Use a more specific code if the affected valve is known. Do not use I38 if the endocarditis is specified as rheumatic.

Medical necessity for the use of I38 is established when the diagnosis of endocarditis has been confirmed, typically by echocardiography and positive blood cultures, and documentation does not specify which heart valve is affected.

In simple words: Inflammation of the inner lining of the heart, affecting an unspecified heart valve.

Endocarditis, valve unspecified. Includes: endocarditis (chronic) NOS, valvular incompetence NOS, valvular insufficiency NOS, valvular regurgitation NOS, valvular stenosis NOS, valvulitis (chronic) NOS. Excludes1: congenital insufficiency of cardiac valve NOS (Q24.8), congenital stenosis of cardiac valve NOS (Q24.8), endocardial fibroelastosis (I42.4), endocarditis specified as rheumatic (I09.1)

Example 1: A patient presents with fever, fatigue, and a new heart murmur. After undergoing an echocardiogram, endocarditis is diagnosed, but the specific valve affected is not clearly identified. I38 is used., A patient with a history of intravenous drug use develops symptoms suggestive of endocarditis. Blood cultures are positive for bacteria, and echocardiography reveals vegetations on a heart valve, but the affected valve is not specified in the report. I38 is used., A patient with a prosthetic heart valve develops endocarditis. While the presence of a prosthetic valve is known, documentation does not specify which valve is affected by the infection. I38 is applicable.

Documentation should include evidence of endocarditis such as positive blood cultures, echocardiographic findings (e.g., vegetations), and clinical symptoms. If the specific valve affected is identified in subsequent diagnostic testing or procedures, the more specific code should be used instead of I38.

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