ICD-10 Coding for Dilated Cardiomyopathy(I42.0, I42.6)
Complete ICD-10-CM coding and documentation guide for Dilated Cardiomyopathy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Dilated Cardiomyopathy
I42-I43Primary Range
Cardiomyopathy
This range includes all types of cardiomyopathy, with I42.0 specifically for dilated cardiomyopathy.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| I42.0 | Dilated cardiomyopathy | Use when dilated cardiomyopathy is diagnosed without a specified cause. |
|
| I42.6 | Alcoholic cardiomyopathy | Use when dilated cardiomyopathy is due to alcohol use. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for dilated cardiomyopathy
Essential facts and insights about Dilated Cardiomyopathy
Primary ICD-10-CM Codes for dilated cardiomyopathy
Decision Criteria
clinical Criteria
- LVEF <45% and LV dilation
Applicable To
- Congestive cardiomyopathy
Clinical Validation Requirements
- LVEF <45%
- LV dilation confirmed by echocardiogram
Code-Specific Risks
- Risk of using unspecified codes which are not covered.
Coding Notes
- Ensure documentation specifies 'dilated' to avoid unspecified codes.
I42.6 - Alcoholic cardiomyopathy
Use when dilated cardiomyopathy is due to alcohol use.
Clinical Validation Requirements
- History of chronic alcohol use
- LVEF <45%
Coding Notes
Document alcohol use clearly to support coding.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Heart failure, unspecified
I50.9Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Dilated Cardiomyopathy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code I42.0.
Impact
Clinical: Leads to inadequate treatment planning., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials.
Mitigation Strategy
Use specific terms like 'dilated' in documentation., Train staff on importance of specificity.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Use I42.6 for alcoholic cardiomyopathy.
Impact
High risk of audit if unspecified codes are used.
Mitigation Strategy
Ensure detailed documentation of cardiomyopathy type and etiology.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Dilated Cardiomyopathy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Dilated Cardiomyopathy
Use these documentation templates to ensure complete and accurate documentation for Dilated Cardiomyopathy. These templates include all required elements for proper coding and billing.
Dilated cardiomyopathy diagnosis
Specialty: CardiologyRequired Elements
- LVEF percentage
- LV dilation measurements
- Etiology if known
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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