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I38 ICD-10-CM Code: Endocarditis, valve unspecified

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

Coding at a Glance

Tabular directives
6 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 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)
  • MS-DRG 791 — PREMATURITY WITH MAJOR PROBLEMS (MDC 15)
  • MS-DRG 793 — FULL TERM NEONATE WITH MAJOR PROBLEMS (MDC 15)

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 I38 in the official ICD-10-CM tabular list, quoted as published.

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

Includes

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

  • endocarditis (chronic) NOS
  • valvular incompetence NOS
  • valvular insufficiency NOS
  • valvular regurgitation NOS
  • valvular stenosis NOS
  • valvulitis (chronic) NOS

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).

Coder workflow for I38

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

Before you code I38

  1. Unspecified does not mean incorrect. When the record gives no greater specificity, I38 may be the appropriate code. Check the record for detail that supports a more specific sibling. An unspecified code is for records that do not provide the detail a more specific code needs; a query, not an assumption, is the route to specificity (Guidelines I.A.9.b, I.B.18).

    See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with I38. 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 record document the detail a more specific sibling code needs?
    Yes → Review the specific siblings in this subcategory.
    No → Continue — I38 is appropriate when the documentation goes no further.
  2. Does the documentation support a condition named in I38’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.

    ReviewQ24.8, I42.4, I09.1

Consider I38. 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).
Any detail beyond this code’s title
What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes1 — check before selecting I38(4 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with I38: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareQ24.8, I42.4, I09.1

    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: The provider documents the condition in the terms of this code’s title and records no further detail.

Coding question: Is a more specific sibling code supportable?

Path: Review the subcategory for a sibling that names the missing detail.

Reason: A more specific code needs documentation of the distinguishing element; without it the unspecified code is appropriate, and a provider query is the route to specificity (Guidelines I.A.9.b, I.B.18).

Documentation: Both the condition I38 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).

ReviewQ24.8, I42.4, I09.1

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

Endocarditis, valve unspecified is a billable ICD-10-CM diagnosis code (I38).

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 (8)

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

  • CC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

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 I38 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: I08 — Multiple valve diseases, I09.1 — Rheumatic diseases of endocardium, valve unspecified, I33 — Acute and subacute endocarditis.

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.

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

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 8 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 4 MS-DRGs: DRG 306 (MDC 05), DRG 307 (MDC 05), DRG 791 (MDC 15), DRG 793 (MDC 15).

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

Clinical classification (AHRQ CCSR):CIR004 — Endocarditis and endocardial 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 process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

I27.841 — Fontan-associated lymphatic dysfunction, I27.848 — Other Fontan-associated condition, I27.849 — Fontan related circulation, unspecified, I87.8 — Other specified disorders of veins, I87.9 — Disorder of vein, unspecified, I99.8 — Other disorder of circulatory system, I99.9 — Unspecified disorder of circulatory system

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Endocarditis and endocardial disease).

A18.84 — Tuberculosis of heart, A32.82 — Listerial endocarditis, A39.51 — Meningococcal endocarditis, A52.03 — Syphilitic endocarditis, A52.06 — Other syphilitic heart involvement, A54.83 — Gonococcal heart infection, B33.21 — Viral endocarditis, B37.6 — Candidal endocarditis, I01.1 — Acute rheumatic endocarditis, I01.8 — Other acute rheumatic heart disease, I01.9 — Acute rheumatic heart disease, unspecified, I02.0 — Rheumatic chorea with heart involvement, I09.9 — Rheumatic heart disease, unspecified, I33.0 — Acute and subacute infective endocarditis, I33.9 — Acute and subacute endocarditis, unspecified, I39 — Endocarditis and heart valve disorders in diseases classified elsewhere, M32.11 — Endocarditis in systemic lupus erythematosus

Same Index main term, other category

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

I35.2 — Nonrheumatic aortic (valve) stenosis with insufficiency (aortic, with insufficiency), I35.8 — Other nonrheumatic aortic valve disorders (aortic), I36.0 — Nonrheumatic tricuspid (valve) stenosis (tricuspid, nonrheumatic), I36.1 — Nonrheumatic tricuspid (valve) insufficiency (tricuspid, nonrheumatic), I36.2 — Nonrheumatic tricuspid (valve) stenosis with insufficiency (tricuspid, nonrheumatic, with insufficiency), I36.8 — Other nonrheumatic tricuspid valve disorders (tricuspid, nonrheumatic), I37.0 — Nonrheumatic pulmonary valve stenosis (pulmonary, valve), I37.1 — Nonrheumatic pulmonary valve insufficiency (pulmonary, valve), I37.2 — Nonrheumatic pulmonary valve stenosis with insufficiency (pulmonary, valve, with insufficiency), I37.8 — Other nonrheumatic pulmonary valve disorders (pulmonary), I42.1 — Obstructive hypertrophic cardiomyopathy (subaortic, hypertrophic), I42.2 — Other hypertrophic cardiomyopathy (myocardium, idiopathic), I42.3 — Endomyocardial (eosinophilic) disease (Löffler's), I50.9 — Heart failure, unspecified (myocardial, myocardium), I51.5 — Myocardial degeneration (myocardium, myocardial), I51.7 — Cardiomegaly (cardiac), I67.81 — Acute cerebrovascular insufficiency (cerebrovascular), I70.0 — Atherosclerosis of aorta (aorta, calcified), I70.1 — Atherosclerosis of renal artery (renal artery), I70.8 — Atherosclerosis of other arteries (artery, celiac, atherosclerosis), +439 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 I38 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 I38 with these 5 related codes in Claim Check

Hierarchy

Excludes1

Referenced by Excludes1 notes

Referenced by Excludes2 notes

  • I08 — Multiple valve diseases[Excludes2]: “multiple valve disease specified as nonrheumatic (I34.-, I35.-, I36.-, I37.-, I38.-, Q22.-, Q23.-, Q24.8-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

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
  • MDC 15 — Newborns and Other Neonates with Conditions Originating in Perinatal Period[MDC crossing]: “Newborns and Other Neonates with Conditions Originating in Perinatal Period — 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.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Disease, diseased, valve, valvular[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Endocarditis (chronic) (marantic) (nonbacterial) (thrombotic) (valvular)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Endocarditis (chronic) (marantic) (nonbacterial) (thrombotic) (valvular), arteriosclerotic[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Hypertrophy, hypertrophic, heart (idiopathic), valve[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Insufficiency, insufficient, valve, valvular (heart)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Stenosis, stenotic (cicatricial), heart valve[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Stenosis, stenotic (cicatricial), valve (cardiac) (heart)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Stricture, heart, valve[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

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. "I38 — Endocarditis, valve unspecified." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/i38-endocarditis-valve-unspecified

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Endocarditis, valve unspecified

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.