2025 ICD-10-CM code I51.89
Other ill-defined heart diseases. This includes conditions such as carditis (acute or chronic) and pancarditis (acute or chronic).
No modifiers are applicable to ICD-10-CM codes.
Medical necessity must be established by demonstrating the need for diagnostic evaluation and treatment of the patient's cardiac symptoms.The fact that a definitive diagnosis is not yet available does not preclude medical necessity as long as the clinical presentation warrants investigation and management of potential cardiac issues. This also applies to diastolic dysfunction coding using I51.89.
Clinicians use this code when they cannot determine a more specific cardiac diagnosis after a thorough evaluation.The clinical responsibility lies in performing appropriate diagnostic testing and providing the best possible care based on the available information, even when a precise diagnosis remains elusive.
- Chapter IX: Diseases of the circulatory system (I00-I99)
- I51 Other forms of heart diseaseI51.8 Other ill-defined heart diseasesI51.89 Other ill-defined heart diseases
In simple words: This code is used when a doctor cannot give a more specific diagnosis for a heart problem. It covers general heart conditions like inflammation of the heart (carditis) or inflammation of all layers of the heart (pancarditis).
Other ill-defined heart diseases.Conditions classified here are those where a more specific diagnosis of heart disease is not available. Examples include acute or chronic carditis and acute or chronic pancarditis.
Example 1: A patient presents with chest pain and shortness of breath.After an EKG, echocardiogram, and cardiac enzyme tests, the physician cannot determine the specific cause of the symptoms.The physician documents "Other ill-defined heart disease" and uses code I51.89., A patient experiences heart palpitations and dizziness.Cardiac monitoring and other tests are inconclusive.In the absence of a definitive diagnosis, the physician documents "Other ill-defined heart disease" and codes the condition as I51.89., A patient with a history of heart problems presents with new symptoms. The provider performs various tests, but they are unable to pinpoint the exact cause of the problem.After consulting with a cardiologist, the provider documents the condition as “Other ill-defined heart disease," coded as I51.89.
Thorough documentation of the patient's symptoms, history, examination findings, and the results of all diagnostic tests performed are essential. The physician should clearly explain why a more specific diagnosis cannot be determined.
** For heart failure cases linked with diastolic dysfunction where a more specific code is not available, I51.89 can be used. Consider iFrameAI for the most up-to-date coding and clinical guidance.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Cardiology, Internal Medicine, Family Medicine
- Place of Service:Inpatient Hospital, On Campus-Outpatient Hospital, Off Campus-Outpatient Hospital, Office,Emergency Room - Hospital,Telehealth Provided in Patient’s Home, Telehealth Provided Other than in Patient’s Home,Nursing Facility