2025 ICD-10-CM code I35.1
(Active) Effective Date: N/A Revision Date: N/A Diseases of the circulatory system - Other forms of heart disease (I30-I5A) Diseases of the circulatory system (I00-I99) Feed
Nonrheumatic aortic valve insufficiency.
Modifiers may be applicable depending on the specific procedure performed and the place of service.Consult local coding guidelines for specifics.
Medical necessity for managing aortic insufficiency is established by the presence of clinically significant symptoms (such as shortness of breath, chest pain, or fatigue) or evidence of left ventricular dysfunction, as documented by echocardiography or other imaging.The severity of the regurgitation justifies the need for treatment, which may range from medical management to surgical intervention.
The clinical responsibility for managing a patient with I35.1 includes diagnosis through history, physical exam, and diagnostic testing (such as echocardiography, electrocardiogram, and cardiac catheterization), treatment planning (which may include medication, interventional procedures, or surgery), monitoring the patient's response to treatment, and educating the patient about their condition and its management.
In simple words: This code describes a heart valve problem where the aortic valve doesn't close completely, allowing blood to flow backward into the heart. This is not caused by rheumatic fever.
Nonrheumatic aortic (valve) insufficiency, also known as nonrheumatic aortic incompetence or nonrheumatic aortic regurgitation, refers to the backflow of blood from the aorta into the left ventricle due to incomplete closure of the aortic valve. This dysfunction can be chronic or acute and is caused by diseases affecting the aortic valve or its surrounding tissue (aortic root).
Example 1: A 60-year-old patient presents with shortness of breath, chest pain, and fatigue.Echocardiography reveals significant aortic regurgitation.Further investigation reveals no evidence of rheumatic heart disease. The diagnosis of I35.1 is made., A 75-year-old patient with a history of hypertension undergoes a cardiac catheterization, which reveals severe aortic insufficiency caused by degenerative valve disease.No prior history of rheumatic fever.Code I35.1 is assigned., A 45-year-old patient with a bicuspid aortic valve (a congenital condition) experiences worsening symptoms of heart failure.Echocardiography shows severe aortic regurgitation.Code I35.1 along with a code for the congenital heart defect should be considered.
Complete documentation should include the patient's history (including symptoms, family history of heart disease), physical examination findings, echocardiogram report (showing severity of regurgitation and valve morphology), and other relevant diagnostic test results (ECG, cardiac catheterization if performed).Any underlying etiology should be documented to ensure proper code selection.
** This code is used to describe nonrheumatic aortic valve insufficiency.The underlying cause of the insufficiency should be considered when coding. If the underlying cause is related to a congenital heart defect, an additional code should be used to specify the congenital heart defect. Always review and adhere to the most current coding guidelines and payer-specific rules.
- Payment Status: Active
- Specialties:Cardiology, Cardiovascular Surgery
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office