ICD-10 code for tricuspid anomaly

The ICD-10-CM code for tricuspid anomaly is Q22.9 (Congenital malformation of tricuspid valve, unspecified). The official index lists 2 more specific codes, so check the documentation for details such as type, cause, site or severity before settling on Q22.9.

Within Q22, choose Q22.9 (Congenital malformation of tricuspid valve, unspecified) only when documentation doesn't support a more specific option: pulmonary valve atresia (Q22.0), congenital pulmonary valve stenosis (Q22.1), congenital pulmonary valve insufficiency (Q22.2), other congenital malformations of pulmonary valve (Q22.3), congenital tricuspid stenosis (Q22.4), Ebstein's anomaly (Q22.5), Hypoplastic right heart syndrome (Q22.6) and other congenital malformations of tricuspid valve (Q22.8).

As a secondary diagnosis it is an MCC (major complication or comorbidity), which can move an inpatient stay into the highest-paying "with MCC" MS-DRG of its family, unless the principal diagnosis excludes it.

In MS-DRG v44.0, it is part of the grouping logic for DRG 306 (Cardiac Congenital and Valvular Disorders with MCC, relative weight 1.546) and DRG 307 (Cardiac Congenital and Valvular Disorders without MCC, relative weight 0.9148), in MDC 05 (Diseases and Disorders of the Circulatory System), as a principal or secondary diagnosis. The DRG a claim lands in depends on the principal diagnosis, procedures and any CC/MCC secondary diagnoses.