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.

Check I05.1 with the rest of the claim: free scrubber

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

A category’s note binds every code beneath it.

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

Their own Excludes1 notes name this code, so the conflict is not listed above.

I34Nonrheumatic mitral valve disorders

Risk adjustment

No CMS-HCC V28 category: this code does not change a RAF score.

Medicare coverage

I05.1 is named in 15 Medicare coverage policies: 15 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A52850Billing and Coding: Cardiac Catheterization and Coronary Angiography
A52868Billing and Coding: Transesophageal Echocardiography (TEE)
A56423Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing
A56476Billing and Coding: Cardiac Radionuclide Imaging

Alphabetic index entries that lead here

Insufficiency, insufficient›mitral›rheumatic

Code history

Unchanged in every release from FY2024 to FY2027.