Bicuspid aortic stenosis and aortic insufficiency

maries7@uw.edumaries7@uw.edu
in Clinical & Coding

A patient with severe symptomatic bicuspid aortic stenosis, moderate aortic insufficiency, and massive valvular and subvalvular calcification, undergoes decalcification of the aortic valve and annulus with aortic valve replacement. 

We cannot code both I35.2 Nonrheumatic aortic (valve) stenosis with insufficiency along with Q23.1 Congenital insufficiency of the aortic valve due to Excludes 1 note.

Would a patient who has a bicuspid valve always present with the calcification/insufficiency due to the congenital valve?  Calcification of the valve can be assigned I35.8 Other nonrheumatic aortic valve disorders. 

What is the most accurate assignment for the principal diagnosis?

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