ICD-10 Logo
ICDxICD-10 Medical Coding
ICD-10 Logo
ICDxICD-10 Medical Coding
ICD 10 CodesDiagnoses
ICD 10 CodesDiagnoses
ICD-10 Logo
ICDxICD-10 Medical Coding

Comprehensive ICD-10-CM code reference with AI-powered search capabilities.

© 2025 ICD Code Compass. All rights reserved.

Browse

  • All Chapters
  • All Categories
  • Diagnoses

Tools

  • AI Code Search
ICD-10-CM codes are maintained by the CDC and CMS. This tool is for reference purposes only.
v1.0.0
ICD-10 Guide
ICD-10 CodesI42.1

I42.1

Billable

Obstructive hypertrophic cardiomyopathy

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

Code Description

ICD-10 I42.1 is a billable code used to indicate a diagnosis of obstructive hypertrophic cardiomyopathy.

Key Diagnostic Point:

Obstructive hypertrophic cardiomyopathy (HCM) is a genetic cardiovascular disorder characterized by abnormal thickening of the heart muscle, particularly affecting the interventricular septum. This hypertrophy can obstruct blood flow from the left ventricle to the aorta, leading to symptoms such as dyspnea, chest pain, palpitations, and syncope. The condition often presents in adolescents or young adults but can occur at any age. The anatomy involved includes the left ventricle, interventricular septum, and mitral valve apparatus, which may also be affected by the hypertrophy. Disease progression can lead to heart failure, arrhythmias, and sudden cardiac death, particularly in younger patients. Diagnosis typically involves echocardiography, which reveals the characteristic thickening of the heart muscle, and may be supplemented by MRI or genetic testing to confirm the diagnosis and assess family history. Clinical management may include lifestyle modifications, medications such as beta-blockers, and in severe cases, surgical interventions like septal myectomy or alcohol septal ablation.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and possibly genetic testing for confirmation.
  • Treatment complexity: Management may involve multiple specialties and interventions.
  • Documentation requirements: Detailed clinical history and imaging results are essential.
  • Coding specificity: Requires precise coding to differentiate from other cardiomyopathies.

Audit Risk Factors

  • Common coding errors: Misclassification with other types of cardiomyopathy.
  • Documentation gaps: Incomplete clinical history or lack of imaging results.
  • Billing challenges: Potential denials if documentation does not support the diagnosis.

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

Genetics

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

Obstructive hypertrophic cardiomyopathy has significant clinical implications, affecting patient quality of life and increasing healthcare utilization due to frequent hospitalizations for heart failure or arrhythmias. The condition is prevalent in certain populations, particularly among athletes, raising concerns about sudden cardiac events. Quality measures focus on early diagnosis and appropriate management to prevent complications, highlighting the importance of awareness and education among healthcare providers.

ICD-9 vs ICD-10

Obstructive hypertrophic cardiomyopathy has significant clinical implications, affecting patient quality of life and increasing healthcare utilization due to frequent hospitalizations for heart failure or arrhythmias. The condition is prevalent in certain populations, particularly among athletes, raising concerns about sudden cardiac events. Quality measures focus on early diagnosis and appropriate management to prevent complications, highlighting the importance of awareness and education among healthcare providers.

Reimbursement & Billing Impact

Reimbursement may vary based on the complexity of care provided, including diagnostic imaging and consultations. Common denials can occur if the documentation does not clearly establish the diagnosis or if the treatment provided is not adequately justified. Best practices include ensuring that all clinical notes, imaging reports, and treatment plans are complete and accurately reflect the patient's condition and the medical necessity of the services rendered.

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 I42.1?

I42.1 specifically covers obstructive hypertrophic cardiomyopathy, characterized by significant left ventricular hypertrophy that obstructs outflow. It is often associated with symptoms of heart failure and arrhythmias.

When should I42.1 be used instead of related codes?

I42.1 should be used when there is documented obstructive hypertrophic cardiomyopathy, as opposed to I42.0, which is for hypertrophic cardiomyopathy without obstruction. The distinction is crucial for treatment and management.

What documentation supports I42.1?

Documentation should include a detailed clinical history, results from echocardiograms showing left ventricular hypertrophy, and any relevant genetic testing results. Clear evidence of obstruction during cardiac imaging is also necessary.