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I36.2

Billable

Nonrheumatic tricuspid (valve) stenosis with insufficiency

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

What This Code Means

A tricuspid valve condition where the valve is both narrowed (stenosis) and leaky (insufficiency), not caused by rheumatic fever, affecting blood flow on the right side of the heart.

Coding Tips

  • •This code specifically requires documentation of both stenosis AND insufficiency; do not use if only one condition is present
  • •Ensure the nonrheumatic etiology is confirmed in the medical record

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