ICD-10 Code I05.1 – Rheumatic mitral insufficiency (2026): Diagnosis, Symptoms & Billing Guide
2026 ICD-10-CM Diagnosis Code I05.1 – Rheumatic mitral insufficiency
What it is
I05.1 identifies rheumatic mitral insufficiency, also called rheumatic mitral regurgitation. It means the mitral valve does not close properly because of rheumatic heart disease, allowing blood to leak backward.
Clinical signs
Clinical features may include a heart murmur, shortness of breath, palpitations, or fatigue. Findings often reflect mitral valve regurgitation in the setting of rheumatic valve damage; check documentation.
When to use this code
Use I05.1 when the provider documents rheumatic mitral insufficiency, rheumatic mitral regurgitation, or rheumatic involvement of the mitral valve with leakage. Use it for confirmed current disease, not a vague history alone. If the record does not clearly link the valve disorder to rheumatic disease, check documentation.
Do not use for
Do not use I05.1 for nonrheumatic mitral regurgitation or unspecified mitral valve disease. Also avoid it when the chart only states a past rheumatic fever history without current rheumatic mitral valve insufficiency.
Coding tip
Confirm that the provider explicitly connects the mitral insufficiency to rheumatic disease before assigning I05.1.