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ICD-10 Guide
ICD-10 CodesI42.6

I42.6

Billable

Alcoholic cardiomyopathy

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

Code Description

ICD-10 I42.6 is a billable code used to indicate a diagnosis of alcoholic cardiomyopathy.

Key Diagnostic Point:

Alcoholic cardiomyopathy is a form of heart disease that results from chronic and excessive alcohol consumption, leading to the deterioration of heart muscle function. Clinically, patients may present with symptoms such as dyspnea, fatigue, palpitations, and signs of heart failure, including peripheral edema and pulmonary congestion. The anatomy involved primarily includes the myocardium, which becomes weakened and dilated, impairing the heart's ability to pump effectively. Disease progression can vary, with some individuals experiencing rapid deterioration while others may remain stable for years. Diagnosis typically involves a thorough clinical history, physical examination, and imaging studies such as echocardiography, which can reveal left ventricular dilation and reduced ejection fraction. Laboratory tests may also be performed to assess liver function and rule out other causes of cardiomyopathy. It is crucial to differentiate alcoholic cardiomyopathy from other forms of dilated cardiomyopathy, as the management and prognosis can differ significantly based on the underlying etiology.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires comprehensive assessment of alcohol history and exclusion of other cardiomyopathies.
  • Treatment complexity: Involves lifestyle modifications, pharmacotherapy, and possibly advanced heart failure management.
  • Documentation requirements: Detailed documentation of alcohol use, symptoms, and diagnostic findings is necessary.
  • Coding specificity: Requires accurate coding to reflect the specific etiology of cardiomyopathy.

Audit Risk Factors

  • Common coding errors: Misclassification with other types of cardiomyopathy.
  • Documentation gaps: Incomplete history of alcohol use or failure to document symptoms adequately.
  • Billing challenges: Potential denials if the link between alcohol use and cardiomyopathy is not clearly established.

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

Addiction 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

Alcoholic cardiomyopathy has significant clinical implications, contributing to heart failure and increased morbidity in populations with high alcohol consumption. It poses a public health challenge due to its association with alcohol abuse, necessitating targeted interventions. Quality measures may focus on screening for alcohol use and managing heart failure symptoms. Understanding the epidemiology of this condition can help healthcare providers develop effective strategies for prevention and treatment, ultimately improving patient outcomes and reducing healthcare utilization.

ICD-9 vs ICD-10

Alcoholic cardiomyopathy has significant clinical implications, contributing to heart failure and increased morbidity in populations with high alcohol consumption. It poses a public health challenge due to its association with alcohol abuse, necessitating targeted interventions. Quality measures may focus on screening for alcohol use and managing heart failure symptoms. Understanding the epidemiology of this condition can help healthcare providers develop effective strategies for prevention and treatment, ultimately improving patient outcomes and reducing healthcare utilization.

Reimbursement & Billing Impact

Reimbursement considerations include the need for clear linkage between the diagnosis and the patient's alcohol consumption. Common denials may arise if the documentation does not adequately support the diagnosis or if there is insufficient evidence of the impact of alcohol on heart function. Best practices include ensuring that all relevant clinical findings are documented and that the coding accurately reflects the patient's condition to avoid billing challenges.

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 I42.6?

I42.6 specifically covers alcoholic cardiomyopathy, which is characterized by heart muscle damage due to chronic alcohol abuse. It is important to document the patient's alcohol consumption history and any related symptoms of heart failure.

When should I42.6 be used instead of related codes?

I42.6 should be used when the cardiomyopathy is directly attributable to alcohol use. It is essential to differentiate it from other types of cardiomyopathy, such as idiopathic or ischemic, which have different underlying causes.

What documentation supports I42.6?

Documentation should include a detailed history of alcohol consumption, clinical symptoms, diagnostic imaging results, and any laboratory findings that support the diagnosis of alcoholic cardiomyopathy.