2027 ICD-10-CM Diagnosis Code I05.1Rheumatic mitral insufficiency

ICD-10-CM Codes›I00–I99›I05-I09›I05

ICD-10-CM I05.1
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

I05.1 is a billable ICD-10-CM diagnosis code for rheumatic mitral insufficiency. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 306 through 307. Coders also document this condition as rheumatic mitral regurgitation. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Chronic rheumatic heart disease.

Code Identity

ICD-10-CM Code
I05.1
Billable Status
Yes — Valid for Submission
Code Describes
Rheumatic mitral insufficiency
Short Description
Rheumatic mitral insufficiency
Same as the full description in the CMS dataset.
Parent Code
I05
Rheumatic mitral valve diseases

Code Classification

ChapterI00–I99Diseases of the circulatory system
SectionI05-I09Chronic rheumatic heart diseases
CategoryI05Rheumatic mitral valve diseases
This CodeI05.1Rheumatic mitral insufficiency

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Rheumatic mitral regurgitation

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to I05.1: its own notes plus those printed at I05 and Chapter 9. A note printed at a category, block or chapter applies to every code under it.

Includes

Further defines, or gives examples of, the content of the category.

From I05 Rheumatic mitral valve diseases applies to 5 codes
  • conditions classifiable to both I05.0 and I05.2-I05.9, whether specified as rheumatic or not

Applicable To

Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.

  • Rheumatic mitral incompetence
  • Rheumatic mitral regurgitation

Excludes1

Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.

On I05.1 itself
  • mitral insufficiency not specified as rheumatic (I34.0)
From I05 Rheumatic mitral valve diseases applies to 5 codes
  • mitral valve disease specified as nonrheumatic (I34.-)
  • mitral valve disease with aortic and/or tricuspid valve involvement (I08.-)

Excludes2

Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.

From Chapter 9 (I00-I99) Diseases of the circulatory system applies to 1,433 codes
  • certain conditions originating in the perinatal period (P04-P96)
  • certain infectious and parasitic diseases (A00-B99)
  • complications of pregnancy, childbirth and the puerperium (O00-O9A)
  • congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
  • endocrine, nutritional and metabolic diseases (E00-E88)
  • injury, poisoning and certain other consequences of external causes (S00-T88)
  • neoplasms (C00-D49)
  • symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
  • systemic connective tissue disorders (M30-M36)
  • transient cerebral ischemic attacks and related syndromes (G45.-)

Source: CMS ICD-10-CM Tabular List. How to read instructional notes.

Referenced in Other NotesGuidance

Instructional notes printed at other codes that name I05.1, its category, or a range that includes it.

Excludes1 2

These codes carry an Excludes1 note naming I05.1: they are not reported together with it, unless the two conditions are unrelated.

  • I34 Nonrheumatic mitral valve disorders
    mitral valve disorder specified as rheumatic (I05.-) names I05.-, which includes this code
  • I01 Rheumatic fever with heart involvement
    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. names I05-I09, which includes this code

Excludes2 1

These codes carry an Excludes2 note naming I05.1: its condition is not part of those codes, and both may be reported when the patient has both.

  • I51 Complications and ill-defined descriptions of heart disease
    heart disease specified as rheumatic (I00-I09) names I00-I09, which includes this code

Code Also 1

These codes say I05.1 may also be needed to fully describe the condition. The note gives no sequencing direction.

  • I27.22 Pulmonary hypertension due to left heart disease
    rheumatic mitral valve diseases (I05.-) names I05.-, which includes this code

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR CIR001
Chronic rheumatic heart disease
Default principal diagnosis: inpatient Yes · outpatient Yes

Clinical InformationClinical

  • Rheumatic Mitral Insufficiency

    mitral valve insufficiency secondary to rheumatic fever.

Patient EducationClinical

Heart Valve Diseases

Heart valve disease happens when one or more of your heart valves don't work well.

The full article covers:

  • What are heart valve diseases?
  • What are the types of heart valve diseases?
  • What causes heart valve diseases?
  • Who is more likely to develop heart valve diseases?
  • What are the symptoms of heart valve diseases?
  • What other problems can heart valve diseases cause?
  • How is heart valve disease diagnosed?
  • What are the treatments for heart valve diseases?

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert I05.1 to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
394.1 Rheumatic mitral insuff
Exact Match The mapping is direct, with no qualifiers.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About I05.1Overview

What is the ICD-10 code for rheumatic mitral insufficiency?

The ICD-10-CM code for rheumatic mitral insufficiency is I05.1 (sometimes written as I051). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

Is I05.1 (Rheumatic mitral valve diseases) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report rheumatic mitral insufficiency on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What MS-DRG does I05.1 group to?

When rheumatic mitral insufficiency is the principal diagnosis on an inpatient stay, it groups to MS-DRG 306, 307, with relative weights from 0.9146 to 1.5457 depending on complications. Higher weights mean higher Medicare reimbursement.

Can I05.1 be reported with I34.0?

Not as a rule. The Excludes1 note on I05.1 lists "mitral insufficiency not specified as rheumatic (I34.0)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).

What is the ICD-9 equivalent of I05.1?

Under the General Equivalence Mappings, rheumatic mitral insufficiency converts to ICD-9-CM 394.1 (rheumatic mitral insuff). The mapping is a direct match.