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