When mitral, aortic, tricuspid and pulmonary valves are all documented as having insufficiency, is I08.8 reported or I08.3 with I37.1?

The rationale in favor of the latter is that the I08 section only names mitral, aortic and tricuspid valves with *no mention of pulmonic* whether rheumatic or not, while the I37 section "Excludes 1" note, only excludes *congenital or specified* rheumatic disorders.