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ICD-10 Guide
ICD-10 CodesI42

I42

Non-billable

Cardiomyopathy

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

Code Description

ICD-10 I42 is a used to indicate a diagnosis of cardiomyopathy.

Key Diagnostic Point:

Cardiomyopathy refers to a group of diseases that affect the heart muscle, leading to a decline in its ability to pump blood effectively. The condition can result from various causes, including genetic factors, long-standing high blood pressure, heart valve disease, and chronic alcohol abuse. Clinically, patients may present with symptoms such as shortness of breath, fatigue, palpitations, and swelling in the legs or abdomen. The anatomy involved primarily includes the myocardium, which is the muscular layer of the heart responsible for contraction. Disease progression can lead to heart failure, arrhythmias, and even sudden cardiac death if left untreated. Diagnostic considerations include a thorough patient history, physical examination, echocardiography, cardiac MRI, and sometimes endomyocardial biopsy to determine the underlying cause. Early detection and management are crucial to improving patient outcomes and preventing complications.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires comprehensive evaluation to differentiate types of cardiomyopathy.
  • Treatment complexity: Management may involve medications, lifestyle changes, and potentially surgical interventions.
  • Documentation requirements: Detailed clinical documentation is necessary to support the diagnosis and treatment plan.
  • Coding specificity: Requires accurate coding to specify the type of cardiomyopathy.

Audit Risk Factors

  • Common coding errors: Misclassification of cardiomyopathy types.
  • Documentation gaps: Incomplete patient history or lack of diagnostic testing results.
  • Billing challenges: Potential denials due to insufficient documentation or unclear coding.

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 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

Cardiomyopathy significantly impacts population health, contributing to heart failure and increased morbidity and mortality rates. It affects a diverse demographic, with varying prevalence based on age, sex, and underlying health conditions. Quality measures for cardiomyopathy management focus on early diagnosis, effective treatment strategies, and patient education to improve outcomes. Understanding healthcare utilization patterns related to cardiomyopathy can aid in resource allocation and improve care delivery.

ICD-9 vs ICD-10

Cardiomyopathy significantly impacts population health, contributing to heart failure and increased morbidity and mortality rates. It affects a diverse demographic, with varying prevalence based on age, sex, and underlying health conditions. Quality measures for cardiomyopathy management focus on early diagnosis, effective treatment strategies, and patient education to improve outcomes. Understanding healthcare utilization patterns related to cardiomyopathy can aid in resource allocation and improve care delivery.

Reimbursement & Billing Impact

reimbursement considerations include the necessity of diagnostic tests and the appropriateness of prescribed therapies. Denials may occur if documentation does not clearly establish the medical necessity of services rendered. Best practices include thorough documentation of patient encounters and ensuring that coding aligns with the clinical findings.

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?

I42 encompasses various types of cardiomyopathy, including dilated cardiomyopathy, hypertrophic cardiomyopathy, restrictive cardiomyopathy, and arrhythmogenic right ventricular cardiomyopathy. Each type has distinct diagnostic criteria and clinical implications.

When should I42 be used instead of related codes?

I42 should be used when the primary diagnosis is cardiomyopathy, particularly when the condition is confirmed through diagnostic testing. It should be differentiated from other heart conditions like heart failure (I50) or ischemic heart disease (I25) based on clinical presentation and diagnostic findings.

What documentation supports I42?

Documentation should include a detailed patient history, results from echocardiograms or MRIs, and any laboratory tests that support the diagnosis of cardiomyopathy. Clinical notes should reflect the symptoms, diagnostic process, and treatment plan.