ICD-10 Coding for Hypertrophic Cardiomyopathy(I42.1, I42.2)
Complete ICD-10-CM coding and documentation guide for Hypertrophic Cardiomyopathy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Hypertrophic Cardiomyopathy
I42-I43Primary Range
Cardiomyopathy
This range includes all types of cardiomyopathy, with specific codes for hypertrophic 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 |
|---|---|---|---|
| I42.1 | Obstructive hypertrophic cardiomyopathy | Use when there is documented obstruction in the left ventricular outflow tract. |
|
| I42.2 | Nonobstructive hypertrophic cardiomyopathy | Use when hypertrophy is present without LVOT obstruction. |
|
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 hypertrophic cardiomyopathy
Essential facts and insights about Hypertrophic Cardiomyopathy
Primary ICD-10-CM Codes for hypertrophic cardiomyopathy
Decision Criteria
clinical Criteria
- Presence of LVOT obstruction with gradient ≥30 mmHg
documentation Criteria
- Specific mention of asymmetric septal hypertrophy and SAM
Applicable To
- Asymmetric septal hypertrophy
- Left ventricular outflow tract obstruction
Excludes
- Nonobstructive hypertrophic cardiomyopathy (I42.2)
Clinical Validation Requirements
- LV wall thickness ≥15 mm
- Systolic anterior motion of the mitral valve
- Resting LVOT gradient ≥30 mmHg
Code-Specific Risks
- Incorrectly coding without documented gradient values
Coding Notes
- Ensure documentation specifies the type of hypertrophy and presence of obstruction.
I42.2 - Nonobstructive hypertrophic cardiomyopathy
Use when hypertrophy is present without LVOT obstruction.
Applicable To
- Concentric hypertrophy
- Apical hypertrophy
Excludes
- Obstructive hypertrophic cardiomyopathy (I42.1)
Clinical Validation Requirements
- LV wall thickness ≥15 mm
- No significant LVOT obstruction
Coding Notes
Document the type of hypertrophy and absence of obstruction.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Hypertrophic Cardiomyopathy to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code I42.1.
Impact
Clinical: May lead to inappropriate treatment decisions., Regulatory: Non-compliance with documentation standards., Financial: Potential for claim denials.
Mitigation Strategy
Use specific terms like 'obstructive' or 'nonobstructive'., Include detailed echocardiogram results.
Impact
Reimbursement: May lead to claim denials or reduced payment., Compliance: Non-compliance with coding guidelines., Data Quality: Impacts the accuracy of clinical data.
Mitigation Strategy
Always specify whether the HCM is obstructive or nonobstructive.
Impact
High denial rates for claims using unspecified codes.
Mitigation Strategy
Ensure specific documentation and coding of HCM type.
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 Hypertrophic Cardiomyopathy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Hypertrophic Cardiomyopathy
Use these documentation templates to ensure complete and accurate documentation for Hypertrophic Cardiomyopathy. These templates include all required elements for proper coding and billing.
Obstructive HCM with Atrial Fibrillation
Specialty: CardiologyRequired Elements
- Maximal LV wall thickness
- LVOT gradient
- Presence of SAM
- Atrial fibrillation status
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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