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ICD-10 Guide
ICD-10 CodesA36.81

A36.81

Diphtheritic cardiomyopathy

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 A36.81 is a billable code used to indicate a diagnosis of diphtheritic cardiomyopathy.

Key Diagnostic Point:

Diphtheritic cardiomyopathy is a serious complication of diphtheria, a bacterial infection caused by Corynebacterium diphtheriae. This condition arises when the toxin produced by the bacteria affects the heart muscle, leading to inflammation and dysfunction. Clinically, patients may present with symptoms such as chest pain, palpitations, and signs of heart failure. The pathophysiology involves the binding of diphtheria toxin to cardiac myocytes, resulting in cellular damage and necrosis. Diagnosis is typically confirmed through clinical evaluation, laboratory tests, and sometimes imaging studies to assess cardiac function. Treatment primarily focuses on the administration of diphtheria antitoxin, antibiotics to eradicate the infection, and supportive care for heart failure symptoms. Early recognition and intervention are crucial to prevent severe complications and improve patient outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of infectious disease pathology.
  • Involves knowledge of cardiac complications from infections.
  • Documentation must specify the relationship between diphtheria and cardiomyopathy.
  • Differentiation from other types of cardiomyopathy is necessary.

Audit Risk Factors

  • Inadequate documentation linking diphtheria to cardiomyopathy.
  • Failure to document the severity of cardiac symptoms.
  • Misuse of codes for other types of cardiomyopathy.
  • Lack of clarity on treatment protocols followed.

Specialty Focus

Medical Specialties

Infectious Disease

Documentation Requirements

Detailed history of infection, treatment protocols, and follow-up care.

Common Clinical Scenarios

Patients presenting with respiratory symptoms and subsequent cardiac complications.

Billing Considerations

Ensure documentation reflects the infectious etiology and its impact on cardiac health.

Cardiology

Documentation Requirements

Comprehensive cardiac evaluation, including echocardiograms and symptom assessment.

Common Clinical Scenarios

Patients with unexplained heart failure symptoms following a recent respiratory infection.

Billing Considerations

Documenting the timeline of infection and cardiac symptoms is critical.

Coding Guidelines

Inclusion Criteria

Use A36.81 When
  • Follow official ICD
  • CM coding guidelines, ensuring accurate documentation of the relationship between diphtheria and cardiomyopathy
  • Include any relevant clinical findings and treatment details

Exclusion Criteria

Do NOT use A36.81 When
No specific exclusions found.

Related CPT Codes

93000CPT Code

Electrocardiogram, ECG

Clinical Scenario

Used to assess cardiac function in patients with diphtheritic cardiomyopathy.

Documentation Requirements

Document the reason for ECG and any findings related to cardiomyopathy.

Specialty Considerations

Cardiology specialists should ensure thorough documentation of cardiac assessments.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of conditions like diphtheritic cardiomyopathy, improving data accuracy and enhancing the ability to track disease prevalence and outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of conditions like diphtheritic cardiomyopathy, improving data accuracy and enhancing the ability to track disease prevalence and outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of conditions like diphtheritic cardiomyopathy, improving data accuracy and enhancing the ability to track disease prevalence and outcomes.

Resources

Clinical References

  • •
    CDC Diphtheria Information

Coding & Billing References

  • •
    CDC Diphtheria Information

Frequently Asked Questions

What are the common symptoms of diphtheritic cardiomyopathy?

Common symptoms include chest pain, palpitations, fatigue, and signs of heart failure such as shortness of breath and edema.