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v1.0.0
ICD-10 Guide
ICD-10 CodesI42.8

I42.8

Billable

Other cardiomyopathies

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 I42.8 is a billable code used to indicate a diagnosis of other cardiomyopathies.

Key Diagnostic Point:

I42.8 refers to 'Other cardiomyopathies,' which encompasses a variety of heart muscle diseases that do not fit into the more common categories of dilated, hypertrophic, or restrictive cardiomyopathy. Clinically, patients may present with symptoms such as dyspnea, fatigue, palpitations, and signs of heart failure. The anatomy involved primarily includes the myocardium, which may be affected by various etiologies including genetic factors, infections, toxins, or autoimmune processes. Disease progression can vary widely; some patients may experience rapid deterioration, while others may have a more indolent course. Diagnostic considerations include echocardiography, MRI, and sometimes endomyocardial biopsy to determine the underlying cause and assess the extent of myocardial involvement. Accurate diagnosis is crucial as treatment strategies can differ significantly based on the specific type of cardiomyopathy and its underlying cause.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors
  • Documentation gaps
  • Billing challenges

Specialty Focus

Medical Specialties

Cardiology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Internal Medicine

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related ICD-10 Codes

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of I42.8 lies in its potential to lead to heart failure and other serious cardiovascular complications if not diagnosed and managed appropriately. Population health impact includes a growing prevalence of cardiomyopathies, necessitating increased healthcare utilization for diagnostics and treatment. Quality measures focus on timely diagnosis and effective management strategies to improve patient outcomes and reduce hospitalizations related to heart failure.

ICD-9 vs ICD-10

The clinical significance of I42.8 lies in its potential to lead to heart failure and other serious cardiovascular complications if not diagnosed and managed appropriately. Population health impact includes a growing prevalence of cardiomyopathies, necessitating increased healthcare utilization for diagnostics and treatment. Quality measures focus on timely diagnosis and effective management strategies to improve patient outcomes and reduce hospitalizations related to heart failure.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the medical necessity for diagnostic tests and treatments is well documented. Common denials may arise from insufficient documentation or failure to demonstrate the medical necessity of the services provided. Best practices include maintaining thorough records of patient evaluations, treatment plans, and follow-up care to support claims.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for I00-I99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for I00-I99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by I42.8?

I42.8 covers various forms of cardiomyopathy that do not fall under the standard classifications, including but not limited to arrhythmogenic right ventricular cardiomyopathy, stress-induced cardiomyopathy, and certain types of non-ischemic cardiomyopathy. Each condition has distinct diagnostic criteria and may require specific management strategies.

When should I42.8 be used instead of related codes?

I42.8 should be used when the cardiomyopathy does not fit into the defined categories of dilated, hypertrophic, or restrictive cardiomyopathy. It is essential to ensure that the specific type of cardiomyopathy is documented clearly to justify the use of this code.

What documentation supports I42.8?

Documentation for I42.8 should include a detailed clinical history, physical examination findings, results from imaging studies (such as echocardiograms or MRIs), and any relevant laboratory tests that support the diagnosis of an unspecified cardiomyopathy. Clear documentation of symptoms and treatment plans is also critical.