Cardiology Coding Alert


Answer 7 FAQs About Cardiomyopathy to Ace Your Claims

Remember: Report I42.0 for dilated cardiomyopathy.

If your cardiologist treats cardiomyopathy, an enlargement or thickening of the heart muscle that makes it challenging for the heart to pump blood throughout the body, you must pay attention to numerous details in the documentation. For example, you should know the specific type of cardiomyopathy the patient has.

Answer the following FAQs to keep your cardiomyopathy coding on track.

Identify Different Kinds of Cardiomyopathy

FAQ 1: What are the different types of cardiomyopathy?

Answer: The three different types of cardiomyopathy are dilated, hypertrophic, and restrictive.

Rely on I42.5 for Restrictive Cardiomyopathy

FAQ 2: How should I report restrictive cardiomyopathy?

Answer: For restrictive cardiomyopathy, report I42.5 (Other restrictive cardiomyopathy). Code I42.5 includes constrictive cardiomyopathy NOS.

When a patient has restrictive cardiomyopathy, their heart muscle can scar and/or stiffen. This stiffening limits the ventricles’ ability to expand when they fill with blood. This type of cardiomyopathy is rare.

Report I42.0 for Dilated Cardiomyopathy

FAQ 3: Which code should you report for dilated cardiomyopathy?

Answer: Report I42.0 (Dilated cardiomyopathy) for dilated cardiomyopathy. This code also includes congestive cardiomyopathy, per ICD-10-CM.

Don’t miss: Dilated cardiomyopathy, the most common kind of cardiomyopathy, occurs when the heart chambers enlarge and lose their ability to contract. This type of cardiomyopathy usually originates in the left ventricle, and, as the disease worsens, it may spread to the right ventricle and to the atria.

Focus on Appropriate Option for Hypertrophic Cardiomyopathy

FAQ 4: I’m new to cardiology coding. Can you please explain what hypertrophic cardiomyopathy is and how I should report it?

Answer: When a patient has hypertrophic cardiomyopathy, their heart muscle thickens and grows stiffer than normal. Due to the thickening of the heart muscle, it has a harder time circulating blood through the body. Hypertrophic cardiomyopathy is normally inherited.

For hypertrophic cardiomyopathy, report either I42.1 (Obstructive hypertrophic cardiomyopathy) or I42.2 (Other hypertrophic cardiomyopathy). Code I42.1 also includes hypertrophic subaortic stenosis (idiopathic) and I42.2 also includes nonobstructive hypertrophic cardiomyopathy, per ICD-10-CM.

Report These Codes for Alcoholic Cardiomyopathy

FAQ 5: According to the documentation, the patient has alcoholic cardiomyopathy and uncomplicated alcohol dependence with intoxication. How many codes do I need to report on my claim?

Answer: You will report two codes on your claim. First, you should report I42.6 (Alcoholic cardiomyopathy) for the alcoholic cardiomyopathy. Then, you should report F10.220 (Alcohol dependence with intoxication, uncomplicated) to describe the presence of alcoholism.

Don’t miss: “There’s another type of cardiomyopathy called Takotsubo Syndrome, also known as stress induced cardiomyopathy or broken heart syndrome,” says Robin Peterson, CPC, CPMA, manager of professional coding and compliance services, Pinnacle Enterprise Risk Consulting Services, LLC in Centennial, Colorado. “This is where a sudden surge of stress hormones can cause one part of the heart to enlarge temporarily, which can lead to short term muscle failure. This cardiomyopathy is one of two that is reversible, the other being alcoholic cardiomyopathy. Report Takotsubo Syndrome with I51.81 (Takotsubo syndrome).

Don’t Forget Multiple Codes on This Claim

FAQ 6: My cardiologist documented that the patient has cardiomyopathy due to drugs and an external agent. How should I handle this?

Answer: First, report the poisoning due to drugs or toxin, if applicable, with codes T36- (Poisoning by, adverse effect of and underdosing of systemic antibiotics) through T65- (Toxic effect of other and unspecified substances), per ICD-10-CM. You should also report an additional code for adverse effect, if applicable, to identify the drug from categories T36- through T50- (Poisoning by, adverse effect of and underdosing of diuretics and other and unspecified drugs, medicaments and biological substances).

The second ICD-10-CM code on your claim should be I42.7 (Cardiomyopathy due to drug and external agent).

Mark Down These Causes of Acquired Cardiomyopathy

FAQ 7: What are some causes of acquired cardiomyopathy?

Answer: Viral diseases that affect the heart muscle or valves, underlying diseases that may cause cardiomyopathy, and side effects from chemotherapy can cause acquired cardiomyopathy.

“The term cardiomyopathy is so broad and nonspecific,” Peterson says. “It’s important to educate providers to document the type and cause of the cardiomyopathy to assign the diagnosis to the highest level of specificity. Also, ask them to clearly link secondary cardiomyopathies to the underlying condition in their documentation.”

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