394.2's ICD-10 Replacement Specifies 'Rheumatic'

I05.2 gives you a good lesson in why your superbill's font matters.

Valve disease diagnosis codes are confusing without a doubt. Get a head start on mastering these diagnoses under ICD-10 with a look at how one of your ICD-9 choices will change when ICD-10 goes into effect in a couple of years' time.

394.2- (Mitral stenosis with insufficiency) - ICD 9 CM code

I05.2- (Rheumatic mitral stenosis with insufficiency) - ICD 10 CM code

Dx definition: Mitral stenosis refers to narrowing (stenosis) of the heart's mitral valve, situated between the left atrium and left ventricle. When the doctor additionally documents insufficiency (or incompetence or regurgitation), you should take a look at the codes listed above. "Rheumatic" happens to be a reference to rheumatic fever, a disease which may end up in heart damage.

Rheumatic: 394.2 is not specific to "rheumatic" mitral stenosis with insufficiency. The ICD-10 descriptor for 105.2 includes the term 'rheumatic', however the 'includes' note under I05 (Rheumatic mitral valve disease) specifies that the range is proper for conditions 'whether specified as rheumatic or not'. Therefore of the documentation specifies the case is rheumatic or if it does not mention the cause, I05.2 will be proper. On the contrary, of the documentation states the disease isn't rheumatic, you'll go for a code from I34.-.

Multiple valve involvement: For 394.x (Diseases of mitral valve), ICD-9 has an excludes note telling you to instead use 396.x if the patient also has aortic valve involvement.

Likewise, ICD-10 guides you to use a different code range (not I05.-) for mitral valve disease if there's aortic valve involvement. You'll instead use I08.- (Multiple valve diseases). This is the same range ICD-10 guides you to use if the patient has tricuspid valve involvement apart from mitral valve disease.

Documentation: In order to ensure you'll be able to choose the most proper ICD-10 code, your clinicians' documentation must point to whether the condition is rheumatic. Also it should specify whether the mitral valve alone is involved.

When you make your ICD-10 coding tools, ensure the "rheumatic/nonrheumatic/unspecified" rules clear, and refer coders to I34.- for non-rheumatic cases. Similarly emphasize that I05.2 is for mitral disease only. If other valves are concerned, the proper code will be found in the I08.- range.

Tip: Just as 394.2, I05.2 is right for mitral stenosis with incompetence or regurgitation; as such stay alert for those terms.

As such, is that a 1 or an I? A 0 or an O? You should distinguish between similar looking characters when you are assigning ICD-10 codes. Code I05.2 is great example of a code that comprises easily confused characters. Bear in mind that your first character is a letter and will be followed by digits. As such I05.2 is the letter "I" followed by the number "0."

Bear in mind: When ICD-10 goes into effect, you should apply the code set and official guidelines in effect for the DOS reported.

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