I05.1 vs I34.0
I05.1 and I34.0 can never be reported together. ICD-10-CM declares them mutually exclusive with an Excludes1 note, meaning the two conditions cannot occur in the same patient — so exactly one of them is correct for any given encounter.
The official note, declared on I05.1
mitral insufficiency not specified as rheumatic (I34.0)
I05.1
Rheumatic mitral insufficiency
Billable
- Chapter 9
- Diseases of the circulatory system
- Section
- I05-I09
Use when the record says
- Rheumatic mitral incompetence
- Rheumatic mitral regurgitation
Indexed under
- Insufficiency, insufficient › mitral › rheumatic
I34.0
Nonrheumatic mitral (valve) insufficiency
Billable
- Chapter 9
- Diseases of the circulatory system
- Section
- I30-I5A
Use when the record says
- Nonrheumatic mitral (valve) incompetence NOS
- Nonrheumatic mitral (valve) regurgitation NOS
Indexed under
- Insufficiency, insufficient › mitral
- Incompetency, incompetent, incompetence › annular › mitral
- Insufficiency, insufficient › mitral › specified cause, except rheumatic
Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027