ICD-10 Coding for Nonischemic Cardiomyopathy (NICM)(I42.8, I42.0, I42.5, I42.6)
Complete ICD-10-CM coding and documentation guide for Nonischemic Cardiomyopathy (NICM). Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Nonischemic Cardiomyopathy (NICM)
I42Primary Range
Cardiomyopathy
This range includes all types of cardiomyopathy, with specific codes for nonischemic variants.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| I42.8 | Other cardiomyopathies | Use when NICM is confirmed without a specific subtype. |
|
| I42.0 | Dilated cardiomyopathy | Use when LV dilation and systolic dysfunction are documented. |
|
| I42.5 | Restrictive cardiomyopathy | Use when restrictive physiology is documented. |
|
| I42.6 | Alcoholic cardiomyopathy | Use when cardiomyopathy is explicitly linked to alcohol use. |
|
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 nonischemic cardiomyopathy
Essential facts and insights about Nonischemic Cardiomyopathy (NICM)
Primary ICD-10-CM Codes for nicm
Decision Criteria
clinical Criteria
- Confirmed absence of ischemia via angiogram.
Applicable To
- Nonischemic cardiomyopathy
Excludes
- Ischemic cardiomyopathy (I25.5)
Clinical Validation Requirements
- Echocardiogram showing LVEF <35%
- Cardiac MRI findings
- BNP levels >400 pg/mL
Code-Specific Risks
- Risk of using unspecified codes when more specific ones are available.
Coding Notes
- Ensure documentation specifies 'nonischemic' to avoid coding errors.
I42.0 - Dilated cardiomyopathy
Use when LV dilation and systolic dysfunction are documented.
Applicable To
- Dilated nonischemic cardiomyopathy
Clinical Validation Requirements
- Echocardiogram showing LV dilation and systolic dysfunction
Coding Notes
Document specific findings like LV dilation to support this code.
I42.5 - Restrictive cardiomyopathy
Use when restrictive physiology is documented.
Applicable To
- Restrictive nonischemic cardiomyopathy
Clinical Validation Requirements
- Echocardiogram showing impaired ventricular filling
Coding Notes
Ensure documentation specifies restrictive physiology.
I42.6 - Alcoholic cardiomyopathy
Use when cardiomyopathy is explicitly linked to alcohol use.
Applicable To
- Cardiomyopathy due to alcohol abuse
Clinical Validation Requirements
- History of chronic alcohol use
- Echocardiogram findings consistent with cardiomyopathy
Coding Notes
Document alcohol use history and link to cardiomyopathy.
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.
Ischemic cardiomyopathy
I25.5Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Nonischemic Cardiomyopathy (NICM) to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code I42.8.
Impact
Clinical: May lead to inappropriate treatment., Regulatory: Increases risk of non-compliance., Financial: Potential for reduced reimbursement.
Mitigation Strategy
Use specific terminology., Document etiology and subtype.
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Increases risk of audit failures., Data Quality: Reduces accuracy of clinical data.
Mitigation Strategy
Ensure documentation specifies the type of cardiomyopathy.
Impact
Risk of audits due to unspecified cardiomyopathy codes.
Mitigation Strategy
Ensure documentation specifies type and cause.
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 Nonischemic Cardiomyopathy (NICM), with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Nonischemic Cardiomyopathy (NICM)
Use these documentation templates to ensure complete and accurate documentation for Nonischemic Cardiomyopathy (NICM). These templates include all required elements for proper coding and billing.
Progress Note for NICM
Specialty: CardiologyRequired Elements
- Subjective symptoms
- Objective findings
- Assessment
- Plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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