Is ICD-10-CM code I09 billable?

No, I09 (Other rheumatic heart diseases) is a non-billable ICD-10-CM code. It must be coded to a more specific subcategory before it can be used for reimbursement.

What chapter does ICD-10-CM code I09 belong to?

I09 belongs to Chapter 9 of the ICD-10-CM tabular list: I00–I99 (Diseases of the Circulatory System).

I09Not billable, use a more specific code below

Other rheumatic heart diseases

In Chronic rheumatic heart diseases (I05-I09), chapter 9: Diseases of the Circulatory System

6 billable codes under I09: 3 are a CC; 1 map to HCC 226 (Heart Failure, Except End-Stage and Acute).A CC or MCC (major CC) is a secondary diagnosis that raises the MS-DRG payment. An HCC counts toward a Medicare Advantage patient's risk score.

Official coding guidelines

From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.

Covers hypertension with heart and kidney disease, coronary artery disease with angina, perioperative stroke, cerebrovascular sequelae, and acute myocardial infarction types and timing.

Hypertension (page 50)
Atherosclerotic Coronary Artery Disease and Angina (page 52)
Intraoperative and Postprocedural Cerebrovascular Accident (page 53)
Sequelae of Cerebrovascular Disease (page 53)
Acute myocardial infarction (AMI) (page 54)

Read Section I.C.9 (page 50)

All codes under I09

I09 can't be used on a claim. Pick a billable code below; grey headings group them.

I09 MS-DRGs

As the principal diagnosis, the billable codes under I09 group to these 10 MS-DRGs (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

DRG 314 Other Circulatory System Diagnoses with MCC (3 of 6 codes)
DRG 315 Other Circulatory System Diagnoses with CC (3 of 6 codes)
DRG 316 Other Circulatory System Diagnoses without CC/MCC (3 of 6 codes)
DRG 306 Cardiac Congenital and Valvular Disorders with MCC (2 of 6 codes)
DRG 307 Cardiac Congenital and Valvular Disorders without MCC (2 of 6 codes)
DRG 291 Heart Failure and Shock with MCC (1 of 6 codes)
DRG 292 Heart Failure and Shock with CC (1 of 6 codes)
DRG 293 Heart Failure and Shock without CC/MCC (1 of 6 codes)
DRG 791 Prematurity with Major Problems (1 of 6 codes)
DRG 793 Full Term Neonate with Major Problems (1 of 6 codes)

Other codes that refer to I09

Notes on these codes point to I09.

I01 Excludes1: chronic diseases of rheumatic origin (I05-I09) unless rheumatic fever is also present or there is evidence of reactivation or activity of the rheumatic process.
I51 Excludes2: heart disease specified as rheumatic (I00-I09)

About the condition

Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.

Heart Valve Diseases

Heart valve disease happens when one or more of your heart valves don't work well. Your heart has four valves: the tricuspid, pulmonary, mitral, and aortic valves. The valves have flaps that open and close. The flaps make sure that blood flows in the right direction through your heart and to the rest of your body. When your heart beats, the flaps open to let blood through. Between heartbeats they close to stop the blood from flowing backwards.

Streptococcal Infections

Strep is short for Streptococcus, a type of bacteria that often lives in your nose and throat. Most strep infections are mild, but some may become serious depending on your overall health.

Code history

Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.