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v1.0.0
ICD-10 Guide
ICD-10 CodesI42.5

I42.5

Billable

Other restrictive cardiomyopathy

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

Code Description

ICD-10 I42.5 is a billable code used to indicate a diagnosis of other restrictive cardiomyopathy.

Key Diagnostic Point:

Other restrictive cardiomyopathy is a form of heart disease characterized by the stiffening of the heart muscle, which impairs the heart's ability to fill with blood properly. This condition can arise from various underlying causes, including infiltrative diseases such as amyloidosis or sarcoidosis, and can lead to heart failure. Clinically, patients may present with symptoms such as dyspnea, fatigue, and edema due to fluid retention. The anatomy involved primarily includes the myocardium, which becomes rigid, affecting diastolic function. Disease progression can vary, but it often leads to worsening heart failure symptoms and may require advanced management strategies. Diagnostic considerations include echocardiography, cardiac MRI, and sometimes endomyocardial biopsy to identify the underlying cause. Early diagnosis and management are crucial to improving patient outcomes and quality of life.

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Restrictive cardiomyopathy, while less common than other forms of cardiomyopathy, has significant clinical implications, particularly in older populations. It can lead to increased hospitalizations and healthcare utilization due to heart failure symptoms. Understanding the epidemiology of this condition is crucial for developing targeted interventions and improving population health outcomes.

ICD-9 vs ICD-10

Restrictive cardiomyopathy, while less common than other forms of cardiomyopathy, has significant clinical implications, particularly in older populations. It can lead to increased hospitalizations and healthcare utilization due to heart failure symptoms. Understanding the epidemiology of this condition is crucial for developing targeted interventions and improving population health outcomes.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of the condition and the necessity for advanced imaging or procedures. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Best practices include ensuring all clinical findings are well-documented and coding accurately to reflect the patient's condition and treatment plan.

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 I42.5?

I42.5 encompasses various forms of restrictive cardiomyopathy not classified elsewhere, including those caused by infiltrative diseases like amyloidosis, radiation therapy effects, and certain genetic disorders. It is essential to identify the underlying cause for appropriate management.

When should I42.5 be used instead of related codes?

I42.5 should be used when a patient presents with restrictive cardiomyopathy that does not fit the definitions of other specific types, such as hypertrophic or dilated cardiomyopathy. Accurate clinical documentation is vital to support the use of this code.

What documentation supports I42.5?

Documentation should include clinical findings, diagnostic imaging results, and any relevant laboratory tests that indicate the presence of restrictive cardiomyopathy. A clear description of symptoms and the patient's functional status is also necessary.