Coding aortic valve disease

October 9th, 2019 / By Rebecca Caux-Harry

There are four valves in the heart that separate either the heart chambers from each other, or separate blood flow from heart blood flow.  They are, in the left heart, the mitral and aortic valves and in the right heart, the tricuspid and pulmonary valves.

The most important valve is the aortic valve. It controls the exodus of blood from the left ventricle which then supplies the system. This valve is normally tricuspid, meaning there are three leaflets that control the release of blood associated with contraction of the heart chamber. A common congenital defect of the aortic valve is a bicuspid valve, meaning there are only two leaflets.

There are two main types of valve disease: stenosis and insufficiency. Stenosis of a heart valve is a narrowing of the valve opening, impeding the expulsion of the heart chamber contents. Stenosis of the aortic valve can negatively impact the patient resulting in fatigue, shortness of breath and poor exercise tolerance.  Additionally, aortic stenosis can negatively impact the structure of the left ventricle causing it to lose efficiency which can lead to heart failure. Think of pushing against a closed door; eventually you will fatigue. 

Aortic valve insufficiency is when the valve leaflets don’t meet to form a seal after allowing the contents of the heart chamber to be expelled. This lack of proper closure allows blood to leak back into the left ventricle, thus regurgitation. Symptoms of aortic insufficiency are basically the same as aortic stenosis. Additionally, the left ventricle can also be damaged, resulting in heart failure.

Coding for aortic valve disease requires the documentation of the type of disease. The disease is assumed to be nonrheumatic unless otherwise stated, but with a caveat. If there is unspecified aortic valve disease with mitral and/or tricuspid valve involvement, the disease is assumed to be rheumatic. Per ICD-10 Excludes 1 note, we are guided to code in the I08.x. 

The most common ICD-10 codes for aortic valve disease are:

I35.0      Nonrheumatic aortic (valve) stenosis

I35.1      Nonrheumatic aortic (valve) insufficiency

I35.2      Nonrheumatic aortic (valve) stenosis with insufficiency

I35.8      Other nonrheumatic aortic valve disorders

I35.9      Nonrheumatic aortic valve disorder, unspecified

 

When the aortic valve disease is documented as rheumatic, the codes are:

I06.0      Rheumatic aortic valve stenosis

I06.1      Rheumatic aortic valve insufficiency

I06.2      Rheumatic aortic valve stenosis with insufficiency

I06.8      Other rheumatic aortic valve diseases

I06.9      Rheumatic aortic valve disease, unspecified

 

When multiple valves are diseased, we assume rheumatic disease and select codes from the following:

I08.0      Rheumatic disorders of both mitral and aortic valves

I08.1      Rheumatic disorders of both mitral and tricuspid valves

I08.2      Rheumatic disorders of both aortic and tricuspid valves

I08.3      Combined rheumatic disorders of mitral, aortic and tricuspid valves

I08.8      Other rheumatic multiple valve diseases

I08.9      Rheumatic multiple valve disease unspecified

 

When aortic valve disease is documented as congenital, the following codes apply:

Q23.0    Congenital stenosis of aortic valve

Q23.1    Congenital insufficiency of aortic valve (bicuspid aortic valve)

Q23.8    Other congenital malformations of aortic and mitral valves

Q23.9    Congenital malformation of aortic and mitral valves, unspecified

So, when coding aortic valve disease, you will need to know if the disease is stenosis or insufficiency or both, also whether other valves are also involved, and if the disease is rheumatic, nonrheumatic or congenital. A simple statement of “valve disease” will not allow you to code to the greatest specificity possible.

Rebecca Caux-Harry, CPC, is a professional fee coding specialist with 3M Health Information Systems.