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2025 ICD-10-CM code I07.1

Rheumatic tricuspid insufficiency.It involves the impaired function of the tricuspid valve due to rheumatic heart disease.

Code I07.1 should be used when rheumatic tricuspid insufficiency is the primary or sole valvular abnormality. If stenosis is also present, I07.2 should be used instead. It's important to differentiate between rheumatic and non-rheumatic tricuspid valve disease; the latter is coded under I36.-.

Medical necessity for treatment is established by the presence of symptoms and the severity of the tricuspid insufficiency. The documentation must support the need for intervention, whether it is medical management or surgical repair or replacement of the valve.

Diagnosis and treatment are typically managed by cardiologists. This involves evaluating the severity of the insufficiency through echocardiography and other diagnostic tests, and then determining the appropriate course of action, which may range from medication to surgical intervention.

In simple words: The tricuspid valve in your heart, which is located between two chambers on the right side, isn't closing properly because of damage caused by rheumatic fever. This allows blood to leak backward when your heart beats, making it less efficient.

Rheumatic tricuspid insufficiency is a disorder characterized by the inability of the heart's tricuspid valve to close properly. This results in the backflow of blood into the right atrium during ventricular contraction. The condition arises as a consequence of rheumatic fever, a complication of streptococcal infections.

Example 1: A 55-year-old patient presents with shortness of breath and fatigue.An echocardiogram reveals tricuspid regurgitation.The patient's medical history includes rheumatic fever as a child. I07.1 is used to code the tricuspid insufficiency., A patient with a known history of rheumatic heart disease develops symptoms of right-sided heart failure. Imaging studies show significant tricuspid valve insufficiency. The diagnosis is coded as I07.1., During a routine check-up, a murmur is detected in a patient who had rheumatic fever several years ago. Further investigation confirms rheumatic tricuspid insufficiency, and I07.1 is assigned.

Documentation should include evidence of previous rheumatic fever or rheumatic heart disease, confirmation of tricuspid insufficiency via echocardiography or other imaging, and the severity of the condition. Specific details regarding valve morphology and function, as well as associated symptoms, should be noted.

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