ICD-10 Guide

Alcoholic Cardiomyopathy

ICD-10 Coding for Alcoholic Cardiomyopathy(I42.6)

PRIMARY SPECIALTYCardiology

COMPLEXITYHigh

LAST UPDATED09/15/2025

Sam Tuffun, PT, DPT

Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Alcoholic Cardiomyopathy?

Essential facts and insights about Alcoholic Cardiomyopathy

Key Clinical Considerations:

Patients typically present with symptoms of heart failure, including dyspnea, fatigue, and edema.
Laboratory findings may include elevated B-type natriuretic peptide (BNP) levels and abnormal liver function tests.
Physical examination may reveal signs of heart failure such as jugular venous distension, crackles on lung auscultation, and peripheral edema.
Imaging findings may include echocardiographic evidence of left ventricular dilation and reduced ejection fraction.
Severity criteria may involve the New York Heart Association (NYHA) functional classification for heart failure.

Clinical Information

Clinical Criteria & Documentation Requirements

Medical records must document the patient's history of alcohol use and its correlation with cardiac symptoms.
Specific terminology such as 'alcoholic cardiomyopathy' and 'heart failure' must be used in the documentation.
Examples include: 'Patient with a history of chronic alcohol use presenting with symptoms consistent with alcoholic cardiomyopathy.'
Documentation must establish medical necessity for diagnostic tests and treatments related to the condition.
Quality measures may include documentation of functional status and treatment response.

Coding Guidelines

Usage Guidelines & Examples

Use this diagnosis code when the patient has a confirmed history of alcohol use leading to heart failure symptoms.
Do not use this code if the heart failure is due to other causes such as ischemic heart disease or hypertension.
Related codes include I42.0 (Dilated cardiomyopathy) and I42.9 (Cardiomyopathy, unspecified), which may be used in different contexts.
Common errors include failing to document the history of alcohol use or misclassifying the type of cardiomyopathy.
In complex cases, ensure to document all contributing factors and consider additional codes for coexisting conditions.

Code Exclusions

Important Exclusions

Conditions explicitly excluded include non-alcoholic cardiomyopathy and heart failure due to ischemic heart disease.
Alternative codes for excluded conditions may include I50 (Heart failure) for non-alcoholic causes.
Conditions are excluded to ensure accurate representation of the etiology of cardiomyopathy.
Common mistakes include misclassifying heart failure due to other etiologies as alcoholic cardiomyopathy.
Related but distinct conditions include hypertensive heart disease and ischemic cardiomyopathy.

Specialty Focus

Primary Specialty

Cardiology

Specialty Applications

This diagnosis applies to patients with a history of significant alcohol consumption leading to cardiac dysfunction.
Patient populations include adults, particularly those with risk factors such as chronic alcohol use and male gender.
Clinical settings include inpatient admissions for heart failure management and outpatient follow-up care.
Specialty-specific applications are relevant in cardiology and addiction medicine.
Treatment contexts include management of heart failure symptoms and interventions for alcohol cessation.

Coding Complexity

High Complexity

This diagnosis requires careful attention to:

Comprehensive clinical documentation
Accurate code selection based on clinical criteria
Proper exclusion considerations
Specialty-specific coding guidelines

Documentation

Documentation Templates

Template 1

Template: 'Patient diagnosed with alcoholic cardiomyopathy based on clinical findings of heart failure and history of alcohol use.'

Template 2

Template: 'Clinical presentation consistent with alcoholic cardiomyopathy including dyspnea and fatigue.'

Template 3

Template: 'Diagnostic criteria for alcoholic cardiomyopathy met as evidenced by echocardiographic findings of left ventricular dilation.'

Template 4

Template: 'Treatment plan initiated for alcoholic cardiomyopathy with diuretics and referral to addiction services.'

Template 5

Template: 'Follow-up care for alcoholic cardiomyopathy including monitoring of heart function and alcohol use.'

Billing Information

Billing Considerations

Ensure proper documentation for billing
Verify code specificity requirements
Check for any additional codes needed
Review payer-specific guidelines

Common Issues

Insufficient clinical documentation
Incorrect code selection
Missing supporting diagnoses
Timing and frequency documentation

Frequently Asked Questions

What documentation is required for this diagnosis?

Documentation must include a detailed history of alcohol use, clinical symptoms, and diagnostic test results.

How does this differ from similar diagnoses?

Alcoholic cardiomyopathy is specifically linked to chronic alcohol use, whereas other cardiomyopathies may have different etiologies.

What are common billing considerations?

Ensure that the diagnosis is clearly linked to the treatment provided to optimize reimbursement.

What procedures are typically associated?

Commonly associated procedures include echocardiography and cardiac monitoring.

Are there any quality reporting implications?

Quality measures may include tracking functional status and treatment adherence in patients with alcoholic cardiomyopathy.

What is Alcoholic Cardiomyopathy?

Essential facts and insights about Alcoholic Cardiomyopathy

Key Clinical Considerations:

Patients typically present with symptoms of heart failure, including dyspnea, fatigue, and edema.
Laboratory findings may include elevated B-type natriuretic peptide (BNP) levels and abnormal liver function tests.
Physical examination may reveal signs of heart failure such as jugular venous distension, crackles on lung auscultation, and peripheral edema.
Imaging findings may include echocardiographic evidence of left ventricular dilation and reduced ejection fraction.
Severity criteria may involve the New York Heart Association (NYHA) functional classification for heart failure.

Alcoholic Cardiomyopathy

Diagnosis Overview

Key Clinical Considerations:

Clinical Information

Clinical Criteria & Documentation Requirements

Coding Guidelines

Usage Guidelines & Examples

Code Exclusions

Important Exclusions

Related ICD-10 Codes

Related CPT Codes

Specialty Focus

Primary Specialty

Specialty Applications

Coding Complexity

Documentation

Documentation Templates

Template 1

Template 2

Template 3

Template 4

Template 5

Billing Information

Billing Considerations

Common Issues

Frequently Asked Questions

What documentation is required for this diagnosis?

How does this differ from similar diagnoses?

What are common billing considerations?

What procedures are typically associated?

Are there any quality reporting implications?

Alcoholic Cardiomyopathy

Diagnosis Overview

Key Clinical Considerations:

Clinical Information

Clinical Criteria & Documentation Requirements

Coding Guidelines

Usage Guidelines & Examples

Code Exclusions

Important Exclusions

Related ICD-10 Codes

Related CPT Codes

Specialty Focus

Primary Specialty

Specialty Applications

Coding Complexity

Documentation

Documentation Templates

Template 1

Template 2

Template 3

Template 4

Template 5

Billing Information

Billing Considerations

Common Issues

Frequently Asked Questions

What documentation is required for this diagnosis?

How does this differ from similar diagnoses?

What are common billing considerations?

What procedures are typically associated?

Are there any quality reporting implications?