ICD-10 Coding for Ischemic Congestive Cardiomyopathy(I25.5)
Complete ICD-10-CM coding and documentation guide for Ischemic Congestive Cardiomyopathy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Ischemic Congestive Cardiomyopathy
I25.5Primary Range
Ischemic cardiomyopathy
Primary code for ischemic cardiomyopathy when coronary artery disease is confirmed.
Heart failure
Used to specify the type and acuity of heart failure associated with ischemic cardiomyopathy.
Atherosclerotic heart disease
Used when coronary artery disease is documented as the underlying cause.
Key Information: ICD-10 code for ischemic congestive cardiomyopathy
Essential facts and insights about Ischemic Congestive Cardiomyopathy
Primary ICD-10-CM Code for ischemic congestive cardiomyopathy
Decision Criteria
clinical Criteria
- Presence of CAD confirmed by angiography
documentation Criteria
- Echocardiogram showing reduced EF
Applicable To
- Ischemic heart disease with cardiomyopathy
Excludes
- Nonischemic cardiomyopathy (I42.-)
Clinical Validation Requirements
- Coronary angiography showing ≥70% stenosis in ≥1 major vessel
- Echocardiography with EF <40%
- Documentation of coronary artery disease
Code-Specific Risks
- Incorrectly coding without confirming CAD
- Using unspecified codes
Coding Notes
- Ensure documentation clearly links ischemic cardiomyopathy to coronary artery disease.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Dilated cardiomyopathy
I42.0Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Ischemic Congestive Cardiomyopathy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code I25.5.
Impact
Clinical: Misrepresentation of patient's condition, Regulatory: Non-compliance with coding standards, Financial: Potential for denied claims
Mitigation Strategy
Ensure CAD is documented in the patient's history, Link CAD to cardiomyopathy in notes
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Non-compliance with ICD-10 specificity requirements., Data Quality: Reduces the accuracy of clinical data.
Mitigation Strategy
Specify the type and acuity of heart failure using I50.- codes.
Impact
Failure to document CAD can lead to audit issues.
Mitigation Strategy
Ensure all CAD findings are clearly documented.
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 Ischemic Congestive Cardiomyopathy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Ischemic Congestive Cardiomyopathy
Use these documentation templates to ensure complete and accurate documentation for Ischemic Congestive Cardiomyopathy. These templates include all required elements for proper coding and billing.
Chronic ischemic cardiomyopathy with systolic heart failure
Specialty: CardiologyRequired Elements
- Ischemic etiology
- Ejection fraction
- Heart failure type and acuity
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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