ICD-10 Code Z95.4

Presence of other heart-valve replacement

Version 2019 Billable Code Unacceptable Principal Diagnosis POA Exempt
ICD-10: Z95.4
Short Description:Presence of other heart-valve replacement
Long Description:Presence of other heart-valve replacement

Valid for Submission

ICD-10 Z95.4 is a billable code used to specify a medical diagnosis of presence of other heart-valve replacement. The code is valid for the year 2019 for the submission of HIPAA-covered transactions.

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)

Information for Medical Professionals

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.

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). The diagnosis code Z95.4 is grouped in the following groups for version MS-DRG V36.0 applicable from 10/01/2018 through 09/30/2019.

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

Convert Z95.4 to ICD-9

The following crosswalk between ICD-10 to ICD-9 is based based on the General Equivalence Mappings (GEMS) information:

  • V42.2 - Heart valve transplant (Approximate Flag)

Present on Admission (POA)

Z95.4 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.

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

Synonyms

The following clinical terms are approximate synonyms:

  • H/O: artificial heart valve
  • H/O: artificial heart valve
  • History of aortic valve replacement
  • History of heart valve repair
  • History of mitral valve replacement
  • History of pulmonary valve replacement
  • History of pulmonary valvuloplasty
  • History of replacement of mitral valve with tissue graft
  • History of tissue graft aortic valve replacement
  • History of tissue graft heart valve replacement
  • History of tissue graft mitral valve replacement

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 Z95.4 are found in the index:


Information for Patients


Heart Valve Diseases

Also called: Valvular heart disease

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

  • Aortic insufficiency (Medical Encyclopedia)
  • Aortic stenosis (Medical Encyclopedia)
  • Aortic valve surgery - minimally invasive (Medical Encyclopedia)
  • Aortic valve surgery - open (Medical Encyclopedia)
  • Bicuspid aortic valve (Medical Encyclopedia)
  • Heart murmurs and other sounds (Medical Encyclopedia)
  • Heart valve surgery (Medical Encyclopedia)
  • Transcatheter aortic valve replacement (Medical Encyclopedia)
  • Tricuspid regurgitation (Medical Encyclopedia)

[Learn More]

ICD-10 Footnotes

General Equivalence Map Definitions
The ICD-10 and ICD-9 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.

  • Approximate Flag - The approximate flag is on, indicating that the relationship between the code in the source system and the code in the target system is an approximate equivalent.
  • No Map Flag - The no map flag indicates that a code in the source system is not linked to any code in the target system.
  • Combination Flag - The combination flag indicates that more than one code in the target system is required to satisfy the full equivalent meaning of a code in the source system.