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I36.1 ICD-10-CM Code: Nonrheumatic tricuspid (valve) insufficiency

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

Coding at a Glance

Tabular directives
2 inclusion terms · 4 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 v44, 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 I36.1 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on I36.1 itself; “inherited from” names the category or block whose note applies here.

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Nonrheumatic tricuspid (valve) incompetence
  • Nonrheumatic tricuspid (valve) regurgitation

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 I36

Coder workflow for I36.1

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

Before you code I36.1

  1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with I36.1. 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 I36.1’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.

    ReviewI07, Q22.4, Q22.8, Q22.9, I08

Consider I36.1. 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 I36.1(4 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with I36.1: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareI07, Q22.4, Q22.8, Q22.9, 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 I36.1 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).

ReviewI07, Q22.4, Q22.8, Q22.9, 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.

Coding context

The comparisons, hierarchy, index entries, guidelines, relationships, risk-adjustment and coverage context a coder commonly needs. Each section names whether it is official source data, a MedCoder-derived relationship or MedCoder editorial.

Don’t confuse I36.1 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of I36.1 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • I07— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of tricuspid valve disorders of unspecified cause moves the case to I07; the two are not reported together unless documented as unrelated.

    Full comparison: I36.1 vs I07 →

  • Q22.4— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of tricuspid valve disorders specified as congenital moves the case to Q22.4; the two are not reported together unless documented as unrelated.

    Full comparison: I36.1 vs Q22.4 →

  • Q22.8— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of tricuspid valve disorders specified as congenital moves the case to Q22.8; the two are not reported together unless documented as unrelated.

    Full comparison: I36.1 vs Q22.8 →

  • Q22.9— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of tricuspid valve disorders specified as congenital moves the case to Q22.9; the two are not reported together unless documented as unrelated.

    Full comparison: I36.1 vs Q22.9 →

  • I08— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of tricuspid valve disorders with aortic and/or mitral valve involvement moves the case to I08; the two are not reported together unless documented as unrelated.

    Full comparison: I36.1 vs I08 →

  • I36.9— Specificity relationship (Review)

    Overlapping diagnoses in the same category.

    Overlapping codes in the same category — the documentation decides which is the more specific fit.

    What moves you there: A record that documents no more than “Nonrheumatic tricuspid valve disorder, unspecified” takes I36.9; specificity in the record moves it back here.

    Full comparison: I36.1 vs I36.9 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Code Overview

Nonrheumatic tricuspid (valve) insufficiency is a billable ICD-10-CM diagnosis code (I36.1).

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 I36.1 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 1 Excludes1 note: I07 — Rheumatic tricuspid valve diseases (via I36.-).

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: I08 — Multiple valve diseases (via I36.-).

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

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 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):CIR003 — Nonrheumatic and unspecified valve disorders (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 (Nonrheumatic and unspecified valve disorders).

I34.8 — Other nonrheumatic mitral valve disorders, I34.81 — Nonrheumatic mitral (valve) annulus calcification, I34.89 — Other nonrheumatic mitral valve disorders, I34.9 — Nonrheumatic mitral valve disorder, unspecified, I35.0 — Nonrheumatic aortic (valve) stenosis, I35.1 — Nonrheumatic aortic (valve) insufficiency, I35.2 — Nonrheumatic aortic (valve) stenosis with insufficiency, I35.8 — Other nonrheumatic aortic valve disorders, I35.9 — Nonrheumatic aortic valve disorder, unspecified, I36.0 — Nonrheumatic tricuspid (valve) stenosis, I36.2 — Nonrheumatic tricuspid (valve) stenosis with insufficiency, I36.8 — Other nonrheumatic tricuspid valve disorders, I36.9 — Nonrheumatic tricuspid valve disorder, unspecified, I37.0 — Nonrheumatic pulmonary valve stenosis, I37.1 — Nonrheumatic pulmonary valve insufficiency, I37.2 — Nonrheumatic pulmonary valve stenosis with insufficiency, I37.8 — Other nonrheumatic pulmonary valve disorders, I37.9 — Nonrheumatic pulmonary valve disorder, unspecified, Z95.2 — Presence of prosthetic heart valve, Z95.3 — Presence of xenogenic heart valve, +4 more

Same Index main term, other category

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

I08.3 — Combined rheumatic disorders of mitral, aortic and tricuspid valves (tricuspid, with, aorticdisease, with mitraldisease), I08.8 — Other rheumatic multiple valve diseases (pulmonary, valve, rheumatic, with aortic, mitral or tricuspiddisease), I09.0 — Rheumatic myocarditis (myocardial, myocardium, rheumatic), I09.89 — Other specified rheumatic heart diseases (pulmonary, valve, rheumatic), I13.2 — Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease (cardiorenal, hypertensive), I24.89 — Other forms of acute ischemic heart disease (coronary), I25.89 — Other forms of chronic ischemic heart disease (coronary, chronic or with a stated duration of over 4 weeks), I34.0 — Nonrheumatic mitral (valve) insufficiency (mitral), I35.1 — Nonrheumatic aortic (valve) insufficiency (aortic), I35.2 — Nonrheumatic aortic (valve) stenosis with insufficiency (aortic, with, stenosis), I37.1 — Nonrheumatic pulmonary valve insufficiency (pulmonary, valve), I37.2 — Nonrheumatic pulmonary valve stenosis with insufficiency (pulmonary, valve, with stenosis), I38 — Endocarditis, valve unspecified (valve, valvular), I50.9 — Heart failure, unspecified (myocardial, myocardium), I67.81 — Acute cerebrovascular insufficiency (cerebrovascular), I73.9 — Peripheral vascular disease, unspecified (peripheral vascular), I77.1 — Stricture of artery (arterial), I87.2 — Venous insufficiency (chronic) (peripheral) (venous), I97.11 — Postprocedural cardiac insufficiency (cardiac, postprocedural), I99.8 — Other disorder of circulatory system (vascular), +74 more

Contextual Map

Every relationship of I36.1 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 I36.1 with these 2 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Referenced by Excludes2 notes

  • I08 — Multiple valve diseases[Excludes2](via I36.-): “multiple valve disease specified as nonrheumatic (I34.-, I35.-, I36.-, I37.-, I38.-, Q22.-, Q23.-, Q24.8-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2027

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. 15,708 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027

Index entries

  • Insufficiency, insufficient, tricuspid (valve) (rheumatic), nonrheumatic[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027

Nearest codes

Change history

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

Deep reference

Published questions and FAQ, every source behind this page with its release and checksum, the date-of-service check and the complete change history.

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 FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 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 — v44 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.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCD code lists 2026-01 · LCD export September 20, 2026 · All releases and sources

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

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. "I36.1 — Nonrheumatic tricuspid (valve) insufficiency." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/i36.1-nonrheumatic-tricuspid-valve-insufficiency

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Nonrheumatic tricuspid (valve) insufficiency

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027, 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 I36.1 in its code family, with their registry titles.

View all codes in the I36 family