Is A42.0 a billable ICD-10-CM code?

Yes. A42.0 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does A42.0 sit in the tabular list?

Certain infectious and parasitic diseases (A00-B99), in the block Other bacterial diseases (A30-A49).

What cannot be coded together with A42.0?

A42.0 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above A42.0 (A42) and apply to it just the same.

A42.0

A42.0 — Pulmonary actinomycosis

Billable / specific codeICD-10-CM

A42.0 is a billable, specific ICD-10-CM code for pulmonary actinomycosis. It is valid for submission on a claim.

Excludes1 inherited from the categories above A42.0

These are not written on A42.0, but they bind it: a note on a category applies to every code beneath it. Billing A42.0 with anything listed here is a denial.

Written on A42 — Actinomycosis

actinomycetoma (B47.1)

Other codes that can never be billed with A42.0

These codes carry an Excludes1 note pointing at A42.0. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading A42.0 alone.

J17Pneumonia in diseases classified elsewhere

Risk adjustment

A42.0 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Medicare coverage

A42.0 is named in 4 Medicare coverage policies — 4 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A56580Billing and Coding: Computerized Axial Tomography (CT), Thorax
A56717Billing and Coding: Respiratory Therapy (Respiratory Care)
A57205Billing and Coding: Oximetry Services
A57224Billing and Coding: Respiratory Care

How A42.0 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to A42.0.

Actinomycosis, actinomycotic›pulmonary
Actinomycosis, actinomycotic›with pneumonia
Pneumonia›in›actinomycosis

Code history

A42.0 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Related codes at this level

Codes that share A42. If A42.0 is not quite right, the correct code is usually one of these.

Questions about A42.0

Is A42.0 a billable ICD-10-CM code?: Yes. A42.0 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does A42.0 sit in the tabular list?: Certain infectious and parasitic diseases (A00-B99), in the block Other bacterial diseases (A30-A49).
What cannot be coded together with A42.0?: A42.0 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above A42.0 (A42) and apply to it just the same.