2025 ICD-10-CM Diagnosis Code Z95.4

Approximate Synonyms

The following list of clinical terms are approximate synonyms, alternative descriptions, or common phrases that might be used by patients, healthcare providers, or medical coders to describe the same condition. These synonyms and related diagnosis terms are often used when searching for an ICD-10 code, especially when the exact medical terminology is unclear. Whether you're looking for lay terms, similar diagnosis names, or common language alternatives, this list can help guide you to the correct ICD-10 classification.

Clinical Classification

Clinical Classifications group individual ICD-10-CM diagnosis codes into broader, clinically meaningful categories. These categories help simplify complex data by organizing related conditions under common clinical themes.

They are especially useful for data analysis, reporting, and clinical decision-making. Even when diagnosis codes differ, similar conditions can be grouped together based on their clinical relevance. Each category is assigned a unique CCSR code that represents a specific clinical concept, often tied to a body system or medical specialty.

Code Edits

The Medicare Code Editor (MCE) detects errors and inconsistencies in ICD-10-CM diagnosis coding that can affect Medicare claim validity. These Medicare code edits help medical coders and billing professionals determine when a diagnosis code is not appropriate as a principal diagnosis, does not meet coverage criteria. Use this list to verify whether a code is valid for Medicare billing and to avoid claim rejections or denials due to diagnosis coding issues.

MS-DRG Mapping for ICD-10-CM Code Z95.4

Diagnosis-Related Groups (DRGs) are used to classify hospital cases for billing and healthcare management. They help standardize how hospitals and other providers are reimbursed for inpatient care. Patients are grouped based on their principal diagnosis into broader categories called Major Diagnostic Categories (MDCs).

Once assigned to a DRG, the hospital receives a set payment for the patient’s care, regardless of the actual services provided. This fixed rate is intended to cover the typical cost of treating patients within that group. The payment amount depends on the DRG's relative weight, which reflects the expected complexity and cost of care based on the severity of the patient’s condition.

Diagnostic related groups encourage healthcare providers to focus on quality and efficiency in patient care while managing costs effectively. The diagnosis code is present in the following groups for version MS-DRG V42.0 applicable from 10/01/2024 through 09/30/2025.

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. Review other POA exempt codes here.

CMS POA Indicator Options and Definitions

Convert Z95.4 to ICD-9-CM

Below are the ICD-9 codes that most closely match this ICD-10 code, based on the General Equivalence Mappings (GEMs). This ICD-10 to ICD-9 crosswalk tool is helpful for coders who need to reference legacy diagnosis codes for audits, historical claims, or approximate code comparisons.

Patient Education

Heart Valve Diseases

What are 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.

If one or more of your heart valves doesn't open or close correctly, it can affect your blood flow and strain your heart. Fortunately, treatment helps most valve diseases.

What are the types of heart valve diseases?

Heart valves can have three basic kinds of problems:

• Regurgitation, or backflow, happens when the flaps of a valve don't close tightly. This allows the blood to leak backwards. A common cause of regurgitation is prolapse, where the flaps of the valve flop or bulge back. Prolapse most often affects the mitral valve.
• Stenosis happens when the flaps of a valve become thick, stiff, or stuck together. This prevents the heart valve from opening all the way. Not enough blood can pass through the valve. Aortic valve stenosis is a common type of stenosis. It affects the valve that controls blood flow into the large artery that carries blood out of the heart to the body.
• Atresia happens when a heart valve did not form properly and does not have an opening for blood to pass through.

Sometimes a valve can have both regurgitation and stenosis.

What causes heart valve diseases?

Some people are born with heart valve disease. This is called congenital heart valve disease. It can happen alone or along with other congenital heart defects. Heart valve disease can also develop over time as you get older or have certain conditions that affect the heart.

Who is more likely to develop heart valve diseases?

Your chance of having heart valve disease is higher if:

• You are older. With age, the heart valves can become thick and stiff.
• You have or have had other conditions that affect your heart and blood vessels. These include:
  • Rheumatic fever. An untreated strep throat can become rheumatic fever, which can harm the heart valves. The damage may not show up for years. Today, most people take antibiotics to cure strep throat before it can cause heart valve damage.
  • Endocarditis. This is a rare infection in the lining of the heart and heart valves. It is usually caused by bacteria in the bloodstream.
  • A heart attack.
  • Heart failure.
  • Coronary artery disease, especially when it affects the aorta (the large artery that carries blood from the heart to the body).
  • High blood pressure.
  • High blood cholesterol.
  • Diabetes.
  • Obesity and overweight.
  • Lack of physical activity.
• A family history of early heart disease:
  • A father or brother who had heart disease younger than 55.
  • A mother or sister who had heart disease younger than 65.
• You were born with an aortic valve that wasn't formed right. Sometimes this will cause problems right away. Other times, the valve may work well enough for years before causing problems.

What are the symptoms of heart valve diseases?

Many people live their whole lives with a heart valve that doesn't work perfectly and never have any problems. But heart valve disease may get worse slowly over time. You may develop signs and symptoms, such as:

• Shortness of breath (feeling like you can't get enough air)
• Fatigue
• Swelling in your feet, ankles, abdomen (belly), or the veins in your neck
• Chest pain when you're physically active
• Arrhythmia, a problem with the rate or rhythm of your heartbeat
• Dizziness or fainting

If you don't get treatment for heart valve disease, the symptoms and strain on your heart may keep getting worse.

What other problems can heart valve diseases cause?

When the valves don't work well, your heart has to pump harder to get enough blood out to the body. Without treatment, this extra workload on your heart can lead to:

• Heart failure
• Stroke
• Blood clots
• Sudden cardiac arrest or death

How is heart valve disease diagnosed?

Your health care provider may listen to your heart with a stethoscope and hear that your heart makes abnormal sounds, such as a click or a heart murmur. These sounds may mean a valve isn't working normally. The provider will usually refer you to a cardiologist, a doctor who specializes in heart diseases.

The doctor will also listen to your heart and will do a physical exam. You will also likely need to have one or more heart tests.

What are the treatments for heart valve diseases?

Most heart valve problems can be treated successfully. Treatment may include:

• Medicines to control your symptoms and keep your heart pumping well
• Heart-healthy lifestyle changes to treat other related heart conditions
• Surgery to repair or replace a valve

It's possible that you may need surgery, even if you don't have symptoms. Fixing the valve can help can prevent future heart problems.

There are many ways to do heart valve surgery. You and your doctor can decide what's best for you, based on your valve problem and general health. Heart valve repair surgery has fewer risks than heart valve replacement. So, when repair is possible, it's preferred over valve replacement.

In some cases, valve replacement is necessary. There are 2 types of replacement valves:

• Biologic valves made from pig, cow, or human tissue. These valves tend to wear out after 10 to 15 years, but some may last longer.
• Mechanical (human-made) valves usually don't wear out. But with a mechanical valve, you usually have to take blood thinners for the rest of your life to prevent blood clots. And your risk of endocarditis (a heart infection) is higher than with a biologic valve.

NIH: National Heart, Lung, and Blood Institute

Code History

• FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
• FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
• FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
• FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
• FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
• FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
• FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
• FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
• FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. This was the first year ICD-10-CM was implemented into the HIPAA code set.