ICD-10 Coding for Hypertrophic Obstructive Cardiomyopathy(I42.1)
Complete ICD-10-CM coding and documentation guide for Hypertrophic Obstructive Cardiomyopathy. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Hypertrophic Obstructive Cardiomyopathy
I42-I43Primary Range
Cardiomyopathy
This range includes all types of cardiomyopathy, with I42.1 specifically for obstructive hypertrophic cardiomyopathy.
Key Information: ICD-10 code for hypertrophic obstructive cardiomyopathy
Essential facts and insights about Hypertrophic Obstructive Cardiomyopathy
Primary ICD-10-CM Code for hypertrophic obstructive cardiomyopathy
Decision Criteria
clinical Criteria
- Presence of LVOT gradient ≥30 mmHg
documentation Criteria
- Documentation must include 'obstructive' and echo findings
Applicable To
- Hypertrophic obstructive cardiomyopathy
- HOCM
Excludes
- Non-obstructive hypertrophic cardiomyopathy (I42.2)
Clinical Validation Requirements
- Echocardiogram showing LVOT gradient ≥30 mmHg
- Systolic anterior motion (SAM) of the mitral valve
- Septal thickness ≥15mm
Code-Specific Risks
- Incorrectly coding as non-obstructive (I42.2) without obstruction documentation
- Missing documentation of SAM
Coding Notes
- Ensure documentation specifies 'obstructive' to avoid denials.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Heart failure, unspecified
I50.9Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Other hypertrophic cardiomyopathy
I42.2Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Hypertrophic Obstructive 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: Leads to misdiagnosis and inappropriate treatment., Regulatory: Non-compliance with coding standards., Financial: Potential for claim denials and reduced reimbursement.
Mitigation Strategy
Educate clinicians on documentation requirements, Implement checklist for cardiomyopathy documentation
Impact
Reimbursement: Incorrect coding can lead to lower reimbursement rates., Compliance: May result in compliance issues during audits., Data Quality: Impacts the accuracy of clinical data.
Mitigation Strategy
Ensure documentation includes 'obstructive' and LVOT gradient.
Impact
Risk of audits due to non-specific documentation of cardiomyopathy.
Mitigation Strategy
Ensure all documentation includes specific terms like 'obstructive' and relevant clinical findings.
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 Obstructive Cardiomyopathy, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Hypertrophic Obstructive Cardiomyopathy
Use these documentation templates to ensure complete and accurate documentation for Hypertrophic Obstructive Cardiomyopathy. These templates include all required elements for proper coding and billing.
Initial Evaluation of HOCM
Specialty: CardiologyRequired Elements
- Patient symptoms
- Family history
- Physical exam findings
- Echocardiogram results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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