Is I42.4 a billable ICD-10-CM code?

Yes. I42.4 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does I42.4 sit in the tabular list?

Diseases of the circulatory system (I00-I99), in the block Other forms of heart disease (I30-I5A).

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.

Inclusion terms

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

Congenital cardiomyopathy
Elastomyofibrosis

Other codes that can never be billed with I42.4

These codes carry an Excludes1 note pointing at I42.4. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading I42.4 alone.

Q24Other congenital malformations of heart
I38Endocarditis, valve unspecified

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.

Medicare coverage

I42.4 is named in 36 Medicare coverage policies — 36 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A52458Automatic External Defibrillators - Policy Article
A52850Billing and Coding: Cardiac Catheterization and Coronary Angiography
A52850Billing and Coding: Cardiac Catheterization and Coronary Angiography
A52850Billing and Coding: Cardiac Catheterization and Coronary Angiography

How I42.4 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 I42.4.

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

Related codes at this level

Codes that share I42. If I42.4 is not quite right, the correct code is usually one of these.

Questions about I42.4

Is I42.4 a billable ICD-10-CM code?: Yes. I42.4 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does I42.4 sit in the tabular list?: Diseases of the circulatory system (I00-I99), in the block Other forms of heart disease (I30-I5A).