I07.1 — Rheumatic tricuspid insufficiency
I07.1 is a billable, specific ICD-10-CM code for rheumatic tricuspid insufficiency. It is valid for submission on a claim.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Tricuspid (valve) insufficiency (rheumatic)
Excludes1 inherited from the categories above I07.1
These are not written on I07.1, but they bind it: a note on a category applies to every code beneath it. Billing I07.1 with anything listed here is a denial.
Other codes that can never be billed with I07.1
These codes carry an Excludes1 note pointing at I07.1. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading I07.1 alone.
- I36Nonrheumatic tricuspid valve disorders
Risk adjustment
I07.1 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
I07.1 is named in 16 Medicare coverage policies — 16 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
- A56423Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing
- A56476Billing and Coding: Cardiac Radionuclide Imaging
How I07.1 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 I07.1.
- Insufficiency, insufficient›tricuspid(valve) (rheumatic)
Code history
I07.1 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 I07. If I07.1 is not quite right, the correct code is usually one of these.
Questions about I07.1
- Is I07.1 a billable ICD-10-CM code?
- Yes. I07.1 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does I07.1 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 I07.1?
- I07.1 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 I07.1 (I07) and apply to it just the same.