I42.4

I42.4: Endocardial fibroelastosis

Billable / specific codeICD-10-CM

I42.4 is a billable, specific ICD-10-CM code for endocardial fibroelastosis. It is valid for submission on a claim.

Check I42.4 with the rest of the claim: free scrubber

Inclusion terms

Alternative wordings a physician may use in the chart for this same code.

Congenital cardiomyopathy
Elastomyofibrosis

Excludes2 inherited from the categories above I42.4

Not part of this code, but both may be coded when both are present.

Written on I42: Cardiomyopathy

ischemic cardiomyopathy (I25.5)
peripartum cardiomyopathy (O90.3)
ventricular hypertrophy (I51.7)

Other codes that can never be billed with I42.4

Their own Excludes1 notes name this code, so the conflict is not listed above.

I38Endocarditis, valve unspecified
Q24Other congenital malformations of heart

Risk adjustment

I42.4 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

I42.4 is named in 24 Medicare coverage policies: 24 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A52458Automatic External Defibrillators - Policy Article
A52850Billing and Coding: Cardiac Catheterization and Coronary Angiography
A52868Billing and Coding: Transesophageal Echocardiography (TEE)
A56476Billing and Coding: Cardiac Radionuclide Imaging

Alphabetic index entries that lead here

Elastomyofibrosis
Fibroelastosis(cordis) (endocardial) (endomyocardial)
Cardiomyopathy›congenital
Sclerosis, sclerotic›subendocardial, congenital
Anomaly, anomalous›heart›fibroelastosis cordis
Cardiomyopathy›newborn›congenital
Newborn›affected by›cardiomyopathy›congenital

Code history

Unchanged in every release from FY2024 to FY2027.