Is I05.1 a billable ICD-10-CM code?

Yes. I05.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does I05.1 sit in the tabular list?

Diseases of the circulatory system (I00-I99), in the block Chronic rheumatic heart diseases (I05-I09).

What cannot be coded together with I05.1?

I05.1 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above I05.1 (I05) and apply to it just the same.

I05.1

I05.1 — Rheumatic mitral insufficiency

Billable / specific codeICD-10-CM

I05.1 is a billable, specific ICD-10-CM code for rheumatic mitral insufficiency. It is valid for submission on a claim.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

mitral insufficiency not specified as rheumatic (I34.0)

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Rheumatic mitral incompetence
Rheumatic mitral regurgitation

Excludes1 inherited from the categories above I05.1

These are not written on I05.1, but they bind it: a note on a category applies to every code beneath it. Billing I05.1 with anything listed here is a denial.

Written on I05 — Rheumatic mitral valve diseases

mitral valve disease specified as nonrheumatic (I34.-)
mitral valve disease with aortic and/or tricuspid valve involvement (I08.-)

Other codes that can never be billed with I05.1

These codes carry an Excludes1 note pointing at I05.1. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading I05.1 alone.

I34Nonrheumatic mitral valve disorders

Risk adjustment

I05.1 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Medicare coverage

I05.1 is named in 26 Medicare coverage policies — 26 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A52850Billing and Coding: Cardiac Catheterization and Coronary Angiography
A52850Billing and Coding: Cardiac Catheterization and Coronary Angiography
A52868Billing and Coding: Transesophageal Echocardiography (TEE)
A52868Billing and Coding: Transesophageal Echocardiography (TEE)

How I05.1 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to I05.1.

Insufficiency, insufficient›mitral›rheumatic

Code history

I05.1 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share I05. If I05.1 is not quite right, the correct code is usually one of these.

Questions about I05.1

Is I05.1 a billable ICD-10-CM code?: Yes. I05.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does I05.1 sit in the tabular list?: Diseases of the circulatory system (I00-I99), in the block Chronic rheumatic heart diseases (I05-I09).
What cannot be coded together with I05.1?: I05.1 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above I05.1 (I05) and apply to it just the same.