2025 ICD-10-CM code I09.81
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Chronic rheumatic heart diseases - Other specified rheumatic heart diseases Diseases of the circulatory system (I00-I99) Feed
Rheumatic heart failure.Use an additional code to specify the type of heart failure (I50.-).
Medical necessity for the diagnosis and treatment of rheumatic heart failure is established through the presence of clinical symptoms and objective findings consistent with the condition.Documentation should demonstrate the need for ongoing management of the patient's heart failure, addressing symptoms and preventing complications.The physician should justify treatment choices based on the patient's specific clinical presentation and response to therapy.Justification for specific investigations, such as echocardiography, should also be provided.
The clinical responsibility for this code involves the diagnosis and management of rheumatic heart failure. This includes a thorough history and physical examination, focusing on the cardiac system.Further investigations such as echocardiography and cardiac biomarkers are crucial for assessment of left ventricular function and identification of the specific type of heart failure. Appropriate treatment, including medications (e.g., diuretics, ACE inhibitors, beta-blockers) and lifestyle modifications, must be implemented based on the severity and type of heart failure.
In simple words: This code is for heart failure caused by rheumatic fever, a condition that can damage the heart valves after a strep throat infection.More information about the specific type of heart failure is needed using another code.
This ICD-10-CM code classifies rheumatic heart failure, a condition where the heart's function is compromised due to rheumatic fever, a complication of streptococcal infection.The code requires the use of an additional code from the I50.- category to specify the type of heart failure present (e.g., I50.0 for acute heart failure, I50.1 for heart failure, unspecified).This ensures complete and accurate clinical documentation.
Example 1: A 45-year-old patient presents with symptoms of shortness of breath, fatigue, and edema.The patient's history reveals a previous episode of rheumatic fever in childhood.Echocardiography confirms reduced left ventricular ejection fraction and mitral valve regurgitation.The diagnosis is rheumatic heart failure with reduced ejection fraction (HFrEF)., A 60-year-old patient with known history of rheumatic heart disease experiences worsening dyspnea on exertion.Cardiac examination reveals a systolic murmur.Echocardiography confirms significant mitral stenosis and mild heart failure. The diagnosis is rheumatic heart failure with mitral stenosis., A 70-year-old patient with long-standing rheumatic heart disease is admitted to the hospital with acute decompensated heart failure.Physical examination reveals pulmonary edema and hypotension.The diagnosis is acute rheumatic heart failure.
Detailed patient history including childhood illnesses (especially rheumatic fever),physical examination focusing on the cardiovascular system (heart sounds, rhythm, murmurs, jugular venous pressure, edema), echocardiogram report showing left ventricular function, valve morphology and function, and any other relevant imaging or laboratory data (e.g., BNP, NT-proBNP).The documentation should clearly specify the type of heart failure present and the severity of the condition.
** This code is for heart failure directly resulting from rheumatic heart disease.Other types of heart failure secondary to other conditions should be coded appropriately.Accurate coding requires comprehensive clinical documentation to support the diagnosis and justify treatment.
- Payment Status: Active
- Specialties:Cardiology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office