I38

I38: Endocarditis, valve unspecified

Billable / specific codeICD-10-CM

I38 is a billable, specific ICD-10-CM code for endocarditis, valve unspecified. It is valid for submission on a claim.

Check I38 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.

congenital insufficiency of cardiac valve NOS (Q24.8)
congenital stenosis of cardiac valve NOS (Q24.8)
endocardial fibroelastosis (I42.4)
endocarditis specified as rheumatic (I09.1)

Includes

Conditions this code covers.

endocarditis (chronic) NOS
valvular incompetence NOS
valvular insufficiency NOS
valvular regurgitation NOS
valvular stenosis NOS
valvulitis (chronic) NOS

Other codes that can never be billed with I38

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

I08Multiple valve diseases
I09.1Rheumatic diseases of endocardium, valve unspecified
I33Acute and subacute endocarditis

Risk adjustment

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

Medicare coverage

I38 is named in 12 Medicare coverage policies: 12 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)
A56476Billing and Coding: Cardiac Radionuclide Imaging
A56500Billing and Coding: Cardiac Catheterization and Coronary Angiography

Alphabetic index entries that lead here

Endocarditis(chronic) (marantic) (nonbacterial) (thrombotic) (valvular)
Disease, diseased›valve, valvular
Endocarditis›arteriosclerotic
Insufficiency, insufficient›valve, valvular(heart)
Stenosis, stenotic›heart valve
Stenosis, stenotic›valve(cardiac) (heart)
Hypertrophy, hypertrophic›heart›valve
Stricture›heart›valve

Code history

Unchanged in every release from FY2024 to FY2027.