I08.9 vs Q22

I08.9 (Rheumatic multiple valve disease, unspecified) compared with Q22 (Congenital malformations of pulmonary and tricuspid valves), from the official CMS tabular data.

Summary

These codes can be reported together when both conditions are documented, because I08.9 lists Q22 under Excludes2, which marks them as distinct conditions.

Official rule

What is different?

The conditions named, billing status and chapter.I08.9 is “Rheumatic multiple valve disease, unspecified”; Q22 is “Congenital malformations of pulmonary and tricuspid valves”. Q22 is a non-billable header; I08.9 is billable. I08.9 sits in I00-I99 — Diseases of the Circulatory System (I00-I99); Q22 in Q00-QA1 — Congenital Malformations, Deformations and Chromosomal Abnormalities (Q00-QA1).

Registry fact

Can these codes be reported together?

Yes, when both are documented.I08.9 lists Q22 under Excludes2: “multiple valve disease specified as nonrheumatic (I34.-, I35.-, I36.-, I37.-, I38.-, Q22.-, Q23.-, Q24.8-)”. Excludes2 marks distinct conditions that may both be reported when both are documented.

Official ruleGuide: Excludes1 vs Excludes2

Is there an Excludes1 relationship?

None.Neither entry carries an Excludes1 note that names the other code. I08.9 carries 2 Excludes1 notes covering other codes; the side-by-side table quotes them.

Official rule

Is there an Excludes2 relationship?

Yes.I08.9’s tabular entry: “multiple valve disease specified as nonrheumatic (I34.-, I35.-, I36.-, I37.-, I38.-, Q22.-, Q23.-, Q24.8-)”. The note covers Q22.

Official ruleGuide: Excludes1 vs Excludes2

Is one more specific?

Not comparable.The codes sit in different categories; specificity is only comparable within one category.

Is one a parent or header code?

One is a header.Q22 is a non-billable header, but I08.9 is not one of its subdivisions.

Registry fact

Are there sequencing instructions?

None.Neither entry carries a Code First or Use Additional Code note that names the other.

Official rule

Are there other coding relationships?

None found.No laterality, encounter-phase, Table of Neoplasms, Table of Drugs and Chemicals, or history-versus-active-disease relationship links these codes.

MedCoder-derived

Official rule: a tabular instructional note or a section of the ICD-10-CM Official Guidelines, quoted as published. Registry fact: the codes’ own published attributes (titles, billable status, position in the hierarchy, code set). MedCoder-derived: a reading MedCoder computes from those facts; it is not itself a rule. How to read the labels

Can these codes be reported together?

Informational

Excludes2 relationship

I08.9

Rheumatic multiple valve disease, unspecified

↔

Q22

Congenital malformations of pulmonary and tricuspid valves

What we found

Yes, when both are documented.I08.9 carries an Excludes2 note covering Q22: “multiple valve disease specified as nonrheumatic (I34.-, I35.-, I36.-, I37.-, I38.-, Q22.-, Q23.-, Q24.8-)”

Excludes2 marks distinct conditions — both may be reported when both are documented.

What to review

Report both only when the documentation supports both conditions; otherwise report the one documented.

Guide: Excludes1 vs Excludes2 Check these on a claim

Why it matters

An Excludes2 note means the excluded condition is not part of the code above it, but a patient can have both. Report both when both are documented.

Source / rule

CMS ICD-10-CM tabular instructional notes

Official guidance behind these answers

Section I.A.12.b — Excludes2 · applies to: Excludes2
A type 2 Excludes note represents “Not included here.” An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.
ICD-10-CM Official Guidelines FY2027

Quoted from the ICD-10-CM Official Guidelines for Coding and Reporting in effect for the release shown. The tabular notes above are the code-level instruction; these sections are the convention that says how such a note is applied. Source document (CMS PDF) · Release and checksum

Side by side

	I08.9Rheumatic multiple valve disease, unspecified	Q22Congenital malformations of pulmonary and tricuspid valves
Billing status	Billable	Non-billable header Report instead: Q22.0, Q22.1, Q22.2, Q22.3, Q22.4
Classification	I00-I99 — Diseases of the Circulatory System (I00-I99)	Q00-QA1 — Congenital Malformations, Deformations and Chromosomal Abnormalities (Q00-QA1)
Definition	Rheumatic multiple valve disease, unspecified is a billable ICD-10-CM diagnosis code (I08.9).	Congenital malformations of pulmonary and tricuspid valves is a non-billable ICD-10-CM category code (Q22).
Includes	multiple valve diseases specified as rheumatic or unspecified	—
Excludes1	endocarditis, valve unspecified (I38) rheumatic valve disease NOS (I09.1)	—
Excludes2	multiple valve disease specified as nonrheumatic (I34.-, I35.-, I36.-, I37.-, I38.-, Q22.-, Q23.-, Q24.8-)	—

Notes are the code’s own tabular entry, quoted as published. A note that names the other code is the one the verdict above rests on.

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Derived from the official CMS ICD-10-CM tabular data (FY2027). A coding-rule comparison, not billing advice: payer-specific edits and medical-necessity policy are outside its scope. All data sources