A36.81: Diphtheritic cardiomyopathy
A36.81 is a billable, specific ICD-10-CM code for diphtheritic cardiomyopathy. It is valid for submission on a claim.
Check A36.81 with the rest of the claim: free scrubberInclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Diphtheritic myocarditis
Other codes that can never be billed with A36.81
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
A36.81 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 227 Cardiomyopathy/Myocarditis0.189 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
A36.81 is named in 4 Medicare coverage policies: 4 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A56781Billing and Coding: Transthoracic Echocardiography (TTE)
- A56900Billing and Coding: Immunizations
- A57306Billing and Coding: Transthoracic Echocardiography (TTE)
- A57326Billing and Coding: Electrocardiograms
Alphabetic index entries that lead here
- Diphtheria, diphtheritic›myocarditis
- Myocarditis›diphtheritic
- Myocarditis›in›diphtheria
Code history
Unchanged in every release from FY2024 to FY2027.