Rheumatic mitral stenosis with insufficiency

This code represents a specific type of heart valve disease where the mitral valve, located between the left atrium and left ventricle, is both narrowed (stenosis) and leaks (insufficiency or regurgitation) due to rheumatic fever. This dual pathology impairs proper blood flow through the heart, leading to increased pressure and potential heart failure.

Use this code when documentation clearly indicates both mitral stenosis and mitral insufficiency are present and are attributed to a rheumatic origin. This diagnosis is typically supported by echocardiogram findings detailing the structural and functional abnormalities of the mitral valve, along with a history of rheumatic fever or evidence of rheumatic heart disease.

• Ensure documentation explicitly links both stenosis and insufficiency to a rheumatic etiology; otherwise, separate codes for non-rheumatic mitral valve disorders may be more appropriate.
• Do not code separate diagnoses for mitral stenosis and mitral insufficiency if both are described as rheumatic and co-exist, as this code captures the combined condition.
• Consider sequencing this code as a primary diagnosis if it is the main reason for the encounter, or as a secondary diagnosis if it is a co-morbidity affecting treatment.