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2025 ICD-10-CM code I05.9

Rheumatic mitral valve disease, unspecified; a chronic condition where the mitral valve is affected, with unspecified type and cause.

Refer to the official ICD-10-CM coding guidelines for proper use of this code. Ensure the documentation supports the use of I05.9 as the most appropriate code given the clinical situation. If the cause and type of rheumatic heart disease is determined later,the appropriate more specific code should be used.

Medical necessity for this code is established based on the clinical presentation and diagnostic findings suggesting mitral valve dysfunction.The lack of precise specification of the type or cause does not negate the medical necessity if the symptoms warrant evaluation and management.

Cardiologist, physician, or other qualified healthcare professional involved in the diagnosis and management of heart valve disease.

IMPORTANT:Consider I05.0 (Mitral stenosis), I05.1 (Rheumatic mitral insufficiency), I05.2 (Mitral stenosis with insufficiency), or I05.8 (Other mitral valve diseases) if more specific information is available.Excludes1: mitral valve disease specified as nonrheumatic (I34.-), mitral valve disease with aortic and/or tricuspid valve involvement (I08.-).

In simple words: This code means there's a problem with the mitral valve (a heart valve) due to a long-term rheumatic condition.The exact problem (leakiness or narrowing) isn't specified, nor is the specific cause.

I05.9, Rheumatic mitral valve disease, unspecified, is an ICD-10-CM code classifying a chronic condition affecting the mitral valve.The specific type of disorder (stenosis, insufficiency, or both) and the underlying cause are not specified. This code encompasses various rheumatic heart diseases impacting the mitral valve, including those not precisely defined or where additional diagnostic information is unavailable.Documentation should specify the valve affected, the temporal parameters (acute, chronic, etc.), type of disorder, and, if known, the causation.The code is used when more specific information is unavailable or not documented.

Example 1: A patient presents with shortness of breath and fatigue.Echocardiography reveals mitral valve dysfunction, but further testing is unable to definitively determine the specific type of valve disease or the cause.Code I05.9 is assigned., An elderly patient with a history of rheumatic fever is found to have a heart murmur.While the echocardiogram suggests mitral valve involvement, the specific type and extent of the valvular abnormality cannot be ascertained, resulting in I05.9 coding., A patient presents to the emergency room with symptoms of heart failure.Initial echocardiogram shows mitral regurgitation, but the underlying etiology is unclear pending additional testing.The physician uses I05.9 pending further diagnostic evaluation.

Detailed history and physical examination, echocardiogram findings (including images and measurements), relevant laboratory tests (if any), and any prior medical records related to rheumatic fever or other potential causes of mitral valve disease are necessary. The documentation must clearly state the uncertainty regarding the specific type of mitral valve disease and its cause.

** This code should be used cautiously, and only when a more specific code is not possible.Always strive to obtain and document as much clinical information as possible to ensure accurate coding.

  • Payment Status: Active
  • Specialties:Cardiology
  • Place of Service:Office, Hospital (Inpatient and Outpatient), Urgent Care Facility
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