I42.5

I42.5: Other restrictive cardiomyopathy

Billable / specific codeICD-10-CM

I42.5 is a billable, specific ICD-10-CM code for other restrictive cardiomyopathy. It is valid for submission on a claim.

Check I42.5 with the rest of the claim: free scrubber

Inclusion terms

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

Constrictive cardiomyopathy NOS

Excludes2 inherited from the categories above I42.5

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)

Risk adjustment

I42.5 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

I42.5 is named in 32 Medicare coverage policies: 32 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)
A56425Billing and Coding: B-type Natriuretic Peptide (BNP) Testing

Alphabetic index entries that lead here

Cardiomyopathy›constrictive NOS
Cardiomyopathy›restrictive NEC

Code history

Unchanged in every release from FY2024 to FY2027.