Coding heart valve disease – combination codes
Created Oct 2012
Reviewed Dec 2019
1. If the patient has heart valve disease of more than one valve e.g. aortic stenosis and mitral regurgitation and only one valve (aortic) is being repaired e.g. TAVI, do you assign the specific code for the one valve (aortic) or the multiple valve disease (aortic and mitral) code?
2. In the cases of multiple disorders of one heart valve e.g. severe aortic stenosis and mild aortic regurgitation do you assign the specific codes for each of the disorders or the combination code?
1. In the case where multiple valve disorders are documented it is clinically important to capture all the valve disorders. Where the documentation does not specify a cause e.g. congenital, non-rheumatic, rheumatic, follow the ICD-10-AM Alphabetic Index and the Excludes note in the Tabular List. In the scenario where aortic stenosis and mitral regurgitation is documented the diagnosis code I08.0 Disorders of both mitral and aortic valves should be assigned and use free text on the code description to further specify the specific disorders.
The codes in I08 Multiple valve diseases sit within the category (I05-I09) Chronic rheumatic heart diseases. As there is a high level of interest in rates of rheumatic heart disease in New Zealand, from a public health perspective it is important to identify where possible if the heart valve disease, and in particular multiple valve disease, is rheumatic or non-rheumatic. Disorders of multiple heart valves that are specific as non-rheumatic are not coded to I08.
2. Where a combination code is available in the classification and multiple disorders of a heart valve are documented assign the combination code. For example, assign the diagnosis code I35.2 Aortic (valve) stenosis with insufficiency for documentation of ‘severe aortic stenosis with regurgitation’.
Heart valve disorders with a severity of mild, moderate and severe should be coded when documented.