I07.1

I07.1: Rheumatic tricuspid insufficiency

Billable / specific codeICD-10-CM

I07.1 is a billable, specific ICD-10-CM code for rheumatic tricuspid insufficiency. It is valid for submission on a claim.

Check I07.1 with the rest of the claim: free scrubber

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

A category’s note binds every code beneath it.

Written on I07: Rheumatic tricuspid valve diseases

tricuspid valve disease specified as nonrheumatic (I36.-)
tricuspid valve disease with aortic and/or mitral valve involvement (I08.-)

Other codes that can never be billed with I07.1

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

I36Nonrheumatic tricuspid valve disorders

Risk adjustment

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

Medicare coverage

I07.1 is named in 11 Medicare coverage policies: 11 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A52850Billing and Coding: Cardiac Catheterization and Coronary Angiography
A56423Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing
A56476Billing and Coding: Cardiac Radionuclide Imaging
A56500Billing and Coding: Cardiac Catheterization and Coronary Angiography

Alphabetic index entries that lead here

Insufficiency, insufficient›tricuspid(valve) (rheumatic)

Code history

Unchanged in every release from FY2024 to FY2027.