ICD-10-CM Code Z95.2

Presence of prosthetic heart valve

Version 2020 Billable Code Unacceptable Principal Diagnosis POA Exempt

Valid for Submission

Z95.2 is a billable code used to specify a medical diagnosis of presence of prosthetic heart valve. The code is valid for the year 2020 for the submission of HIPAA-covered transactions. The ICD-10-CM code Z95.2 might also be used to specify conditions or terms like closing click of prosthetic valve, h/o: artificial heart valve, h/o: heart valve recipient, history of aortic valve replacement, history of heart valve repair, history of heart valve repair with prosthesis, etc The code is exempt from present on admission (POA) reporting for inpatient admissions to general acute care hospitals.

The code Z95.2 describes a circumstance which influences the patient's health status but not a current illness or injury. The code is unacceptable as a principal diagnosis.

ICD-10:Z95.2
Short Description:Presence of prosthetic heart valve
Long Description:Presence of prosthetic heart valve

Tabular List of Diseases and Injuries

The Tabular List of Diseases and Injuries is a list of ICD-10 codes, organized "head to toe" into chapters and sections with guidance for inclusions, exclusions, descriptions and more. The following references are applicable to the code Z95.2:

Inclusion Terms

Inclusion Terms
These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
  • Presence of heart valve NOS

Index to Diseases and Injuries

The Index to Diseases and Injuries is an alphabetical listing of medical terms, with each term mapped to one or more ICD-10 code(s). The following references for the code Z95.2 are found in the index:


Code Edits

The Medicare Code Editor (MCE) detects and reports errors in the coding of claims data. The following ICD-10 Code Edits are applicable to this code:

  • Unacceptable principal diagnosis - There are selected codes that describe a circumstance which influences an individual’s health status but not a current illness or injury, or codes that are not specific manifestations but may be due to an underlying cause. These codes are considered unacceptable as a principal diagnosis.

Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

  • Closing click of prosthetic valve
  • H/O: artificial heart valve
  • H/O: heart valve recipient
  • History of aortic valve replacement
  • History of heart valve repair
  • History of heart valve repair with prosthesis
  • History of mechanical aortic valve replacement
  • History of mechanical heart valve replacement
  • History of mechanical mitral valve replacement
  • History of mechanical prosthetic mitral valve replacement
  • History of mitral valve prosthesis
  • History of mitral valve replacement
  • History of repair of mitral valve
  • History of replacement of mitral valve with tissue graft
  • History of tricuspid valve replacement
  • Metal mitral valve prosthesis in situ
  • Opening click of prosthetic valve
  • Prosthetic heart valve in situ
  • Prosthetic valve sound
  • Prosthetic valve sound
  • Prosthetic valve sound
  • Prosthetic valve sound muffled

Diagnostic Related Groups

The ICD-10 code Z95.2 is grouped in the following groups for version MS-DRG V37.0 What are Diagnostic Related Groups?
The Diagnostic Related Groups (DRGs) are a patient classification scheme which provides a means of relating the type of patients a hospital treats. The DRGs divides all possible principal diagnoses into mutually exclusive principal diagnosis areas referred to as Major Diagnostic Categories (MDC).
applicable from 10/01/2019 through 09/30/2020.

  • 314 - OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC
  • 315 - OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC
  • 316 - OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC

Present on Admission (POA)

Z95.2 is exempt from POA reporting - The Present on Admission (POA) indicator is used for diagnosis codes included in claims involving inpatient admissions to general acute care hospitals. POA indicators must be reported to CMS on each claim to facilitate the grouping of diagnoses codes into the proper Diagnostic Related Groups (DRG). CMS publishes a listing of specific diagnosis codes that are exempt from the POA reporting requirement. Review other POA exempt codes here .

CMS POA Indicator Options and Definitions
POA Indicator CodePOA Reason for CodeCMS will pay the CC/MCC DRG?
YDiagnosis was present at time of inpatient admission.YES
NDiagnosis was not present at time of inpatient admission.NO
UDocumentation insufficient to determine if the condition was present at the time of inpatient admission.NO
WClinically undetermined - unable to clinically determine whether the condition was present at the time of inpatient admission.YES
1Unreported/Not used - Exempt from POA reporting. NO

Convert Z95.2 to ICD-9

  • V43.3 - Heart valve replac NEC (Approximate Flag)

Code Classification

  • Factors influencing health status and contact with health services (Z00–Z99)
    • Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99)
      • Presence of cardiac and vascular implants and grafts (Z95)

Code History

  • FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016
    (First year ICD-10-CM implemented into the HIPAA code set)
  • FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
  • FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
  • FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
  • FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020

Information for Patients


Heart Valve Diseases

Your heart has four valves. Normally, these valves open to let blood flow through or out of your heart, and then shut to keep it from flowing backward. But sometimes they don't work properly. If they don't, you could have

  • Regurgitation - when blood leaks back through the valve in the wrong direction
  • Mitral valve prolapse - when one of the valves, the mitral valve, has "floppy" flaps and doesn't close tightly. It's one of the most common heart valve conditions. Sometimes it causes regurgitation.
  • Stenosis - when the valve doesn't open enough and blocks blood flow

Valve problems can be present at birth or caused by infections, heart attacks, or heart disease or damage. The main sign of heart valve disease is an unusual heartbeat sound called a heart murmur. Your doctor can hear a heart murmur with a stethoscope. But many people have heart murmurs without having a problem. Heart tests can show if you have a heart valve disease. Some valve problems are minor and do not need treatment. Others might require medicine, medical procedures, or surgery to repair or replace the valve.

NIH: National Heart, Lung, and Blood Institute


[Learn More]