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ICD-10 Guide
ICD-10 CodesI42.2

I42.2

Billable

Other hypertrophic cardiomyopathy

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

Code Description

ICD-10 I42.2 is a billable code used to indicate a diagnosis of other hypertrophic cardiomyopathy.

Key Diagnostic Point:

I42.2 refers to 'Other hypertrophic cardiomyopathy,' a condition characterized by abnormal thickening of the heart muscle, particularly affecting the interventricular septum. This condition can lead to obstructive or non-obstructive forms of hypertrophic cardiomyopathy, resulting in impaired cardiac function. Clinically, patients may present with symptoms such as dyspnea, chest pain, palpitations, and syncope. The anatomy involved includes the left ventricle, which may become stiff and less able to relax, leading to diastolic dysfunction. Disease progression can vary widely; some patients remain asymptomatic, while others may develop severe heart failure or arrhythmias. Diagnostic considerations include echocardiography, which is essential for visualizing the hypertrophy, and genetic testing may be warranted in familial cases. Other imaging modalities, such as MRI, can provide additional insights into myocardial structure and function.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires thorough evaluation and imaging studies.
  • Treatment complexity: Management may involve medications, lifestyle changes, or surgical interventions.
  • Documentation requirements: Detailed clinical notes and imaging reports are necessary.
  • Coding specificity: Requires differentiation from other types of cardiomyopathy.

Audit Risk Factors

  • Common coding errors: Misclassification with other cardiomyopathy codes.
  • Documentation gaps: Incomplete clinical history or lack of imaging results.
  • Billing challenges: Potential denials due to insufficient documentation.

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Hypertrophic cardiomyopathy, including I42.2, has significant clinical implications, affecting a substantial portion of the population, particularly young athletes. Its impact on population health includes increased risk of sudden cardiac death and heart failure. Quality measures focus on early diagnosis and management to improve patient outcomes. Understanding healthcare utilization patterns is crucial, as patients may require frequent monitoring and interventions, leading to increased healthcare resource use.

ICD-9 vs ICD-10

Hypertrophic cardiomyopathy, including I42.2, has significant clinical implications, affecting a substantial portion of the population, particularly young athletes. Its impact on population health includes increased risk of sudden cardiac death and heart failure. Quality measures focus on early diagnosis and management to improve patient outcomes. Understanding healthcare utilization patterns is crucial, as patients may require frequent monitoring and interventions, leading to increased healthcare resource use.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that all services provided are medically necessary and properly documented. Common denials may arise from insufficient documentation or failure to meet medical necessity criteria. Best practices include maintaining thorough records of patient interactions, diagnostic tests, and treatment responses to facilitate smooth billing processes.

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 I42.2?

I42.2 encompasses various forms of hypertrophic cardiomyopathy that do not fall under specific genetic or other defined categories. This includes cases where the cause is unknown or multifactorial, and it may also include secondary hypertrophy due to other conditions.

When should I42.2 be used instead of related codes?

I42.2 should be used when the hypertrophic cardiomyopathy does not fit into the more specific categories such as I42.0 (Hypertrophic cardiomyopathy due to genetic conditions) or I42.1 (Hypertrophic cardiomyopathy due to other conditions). Proper clinical evaluation is essential for accurate coding.

What documentation supports I42.2?

Documentation should include a comprehensive clinical assessment, echocardiographic findings, any relevant genetic testing results, and a detailed history of symptoms. Clear notes on the patient's functional status and any treatments attempted are also crucial.