Consider Peripartum Status When Coding Cardiomyopathy
Question: A patient was referred to a cardiologist after having shortness of breath. The patient gave birth to a child within the past two months. The cardiologist performed an exam, asked the patient about their personal and family medical history, and diagnosed the patient with cardiomyopathy during postpartum period. Is I42.9 the correct ICD-10-CM code? Washington, D.C. Subscriber Answer: Your initial code choice is probably not specific enough, especially because the cardiologist documented “cardiomyopathy during postpartum period.” If you look at the guideline notes for ICD-10-CM code I42.9 (Cardiomyopathy, unspecified), you’ll see that there are three Excludes2 conditions: ischemic cardiomyopathy, peripartum cardiomyopathy, and ventricular hypertrophy. You may still need to query the cardiologist, because the correct code choice depends on when the cardiomyopathy developed. While the cardiologist’s documentation says “postpartum,” the documentation does not clearly specify when the condition started. If the cardiomyopathy developed within five months of giving birth — and this patient falls within that window — it may be considered peripartum cardiomyopathy, which you could report with O90.3 (Peripartum cardiomyopathy). The Excludes1 note for this code on AAPC’s Codify says “pre-existing heart disease complicating pregnancy and the puerperium (O99.4-)” — so if the patient had cardiomyopathy diagnosed before pregnancy, you may need to look to an O99.4- (Diseases of the circulatory system complicating pregnancy, childbirth and the puerperium) code. Rachel Dorrell, MA, MS, CPC-A, Production Editor, AAPC
