Skip to main content

I05.0 ICD-10-CM Code: Rheumatic mitral stenosis

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
2 inclusion terms · 2 Excludes1

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 306 — CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC (MDC 05)
  • MS-DRG 307 — CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC (MDC 05)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for I05.0 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on I05.0 itself; “inherited from” names the category or block whose note applies here.

Includes

Conditions the official ICD-10-CM tabular list includes under this code.

  • conditions classifiable to both I05.0 and I05.2-I05.9, whether specified as rheumatic or not
    I05.2-I05.9: I05.2, I05.8, I05.9

Source: inherited from I05

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Mitral (valve) obstruction (rheumatic)

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Source: inherited from I05

Coder workflow for I05.0

MedCoder structured workflow — derived from this code’s own official record

Before you code I05.0

  1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with I05.0. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in I05.0’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewI34, I08

Consider I05.0. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

Official instructions as workflow

  • Excludes1 — check before selecting I05.0(2 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with I05.0: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareI34, I08

    See the official tabular notes · Guidelines I.A.12.a

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition I05.0 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewI34, I08

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Rheumatic mitral stenosis is a billable ICD-10-CM diagnosis code (I05.0).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (1)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name I05.0 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 3 Excludes1 notes: I01 — Rheumatic fever with heart involvement (via I05.-), I34 — Nonrheumatic mitral valve disorders (via I05.-), I34 — Nonrheumatic mitral valve disorders.

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 1 Excludes2 note: I51 — Complications and ill-defined descriptions of heart disease (via I05.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 1 Code Also instruction: I27.22 — Pulmonary hypertension due to left heart disease (via I05.-).

These codes suggest coding this condition alongside when both are present.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 2 MS-DRGs: DRG 306 (MDC 05), DRG 307 (MDC 05).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):CIR001 — Chronic rheumatic heart disease (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Chronic rheumatic heart disease).

I05.1 — Rheumatic mitral insufficiency, I05.2 — Rheumatic mitral stenosis with insufficiency, I05.8 — Other rheumatic mitral valve diseases, I05.9 — Rheumatic mitral valve disease, unspecified, I06.0 — Rheumatic aortic stenosis, I06.1 — Rheumatic aortic insufficiency, I06.2 — Rheumatic aortic stenosis with insufficiency, I06.8 — Other rheumatic aortic valve diseases, I06.9 — Rheumatic aortic valve disease, unspecified, I07.0 — Rheumatic tricuspid stenosis, I07.1 — Rheumatic tricuspid insufficiency, I07.2 — Rheumatic tricuspid stenosis and insufficiency, I07.8 — Other rheumatic tricuspid valve diseases, I07.9 — Rheumatic tricuspid valve disease, unspecified, I08.0 — Rheumatic disorders of both mitral and aortic valves, I08.1 — Rheumatic disorders of both mitral and tricuspid valves, I08.2 — Rheumatic disorders of both aortic and tricuspid valves, I08.3 — Combined rheumatic disorders of mitral, aortic and tricuspid valves, I08.8 — Other rheumatic multiple valve diseases, I08.9 — Rheumatic multiple valve disease, unspecified, +6 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Stenosis, stenotic”; these codes share that main term but sit in a different category of the Tabular List.

H04.55 — Acquired stenosis of nasolacrimal duct (lacrimal, duct), H04.56 — Stenosis of lacrimal punctum (lacrimal, punctum), H04.57 — Stenosis of lacrimal sac (lacrimal, sac), H61.30 — Acquired stenosis of external ear canal, unspecified (external ear canal), H61.31 — Acquired stenosis of external ear canal secondary to trauma (external ear canal, due to, trauma), H61.32 — Acquired stenosis of external ear canal secondary to inflammation and infection (external ear canal, due to, inflammation), H61.39 — Other acquired stenosis of external ear canal (external ear canal, specified cause NEC), H95.81 — Postprocedural stenosis of external ear canal (external ear canal, postprocedural), I01.1 — Acute rheumatic endocarditis (mitral, active or acute), I02.0 — Rheumatic chorea with heart involvement (mitral, active or acute, with rheumatic or Sydenham's chorea), I06.0 — Rheumatic aortic stenosis (aortic, rheumatic), I06.2 — Rheumatic aortic stenosis with insufficiency (aortic, rheumatic, with, incompetency, insufficiency or regurgitation), I07.0 — Rheumatic tricuspid stenosis (tricuspid), I07.2 — Rheumatic tricuspid stenosis and insufficiency (tricuspid, with, incompetency, insufficiency or regurgitation), I08.0 — Rheumatic disorders of both mitral and aortic valves (mitral, with, aortic valve disease), I08.1 — Rheumatic disorders of both mitral and tricuspid valves (tricuspid, with, mitraldisease), I08.2 — Rheumatic disorders of both aortic and tricuspid valves (tricuspid, with, aorticdisease), I08.3 — Combined rheumatic disorders of mitral, aortic and tricuspid valves (tricuspid, with, mitraldisease, with aorticdisease), I08.8 — Other rheumatic multiple valve diseases (pulmonary, valve, rheumatic, with aortic, mitral or tricuspiddisease), I09.89 — Other specified rheumatic heart diseases (pulmonary, valve, rheumatic), +168 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Prothrombin Time Test and INR (PT/INR)

Contextual Map

Every relationship of I05.0 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run I05.0 with these 4 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Referenced by Excludes2 notes

Referenced by Code Also instructions

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • MDC 05 — Diseases and Disorders of the Circulatory System[MDC crossing]: “Diseases and Disorders of the Circulatory System — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 17,209 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Stenosis, stenotic (cicatricial), mitral (chronic) (inactive) (valve)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "I05.0 — Rheumatic mitral stenosis." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/i05.0-rheumatic-mitral-stenosis

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Rheumatic mitral stenosis

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to I05.0 in its code family, with their registry titles.

View all codes in the I05 family