Ask Dr. Z

Our cardiologists perform a lot of echo interpretations on patients they have never seen (hospital patients, referred by other providers, etc.). We will frequently see "bicuspid aortic valve" on an echo interpretation in addition to "aortic stenosis." There is an Excludes1 note under I35.0 aortic stenosis that prevents Q23.1 from being reported with it (Excludes1: Aortic valve disorder specified as congenital, Q23.0, Q23.1). How are we to report "bicuspid aortic valve, aortic stenosis"? Going one step further, if patient has bicuspid aortic valve with a mitral and tricuspid valve condition, this same Excludes1 note prevents us from assigning the I08 code with the bicuspid Q23.1. Would these fall under the "exception to the Excludes1 definition as the circumstance when the two conditions are unrelated to each other"? I understand that a provider query is preferred, but our providers are reading these studies only and have no knowledge of the patient for us to query.