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I07.1

Billable

Rheumatic tricuspid insufficiency

This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).

What This Code Means

This condition occurs when the tricuspid valve in the heart (which controls blood flow from the right atrium to the right ventricle) leaks due to damage from rheumatic fever. Blood flows backward into the right atrium, causing the heart to work less efficiently.

Coding Tips

  • •Verify documentation confirms rheumatic origin of the tricuspid insufficiency, as non-rheumatic causes would use different codes (I36.9 or I37.1)
  • •Check for associated conditions like rheumatic mitral or aortic valve disease, which may require additional codes from the I05-I09 range

Code Hierarchy

└I07Rheumatic tricuspid valve diseases└I07.1Rheumatic tricuspid insufficiency
└I07.1Rheumatic tricuspid insufficiency

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