Is I42.7 a billable ICD-10-CM code?

Yes. I42.7 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does I42.7 sit in the tabular list?

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

I42.7

I42.7 — Cardiomyopathy due to drug and external agent

Billable / specific codeICD-10-CM

I42.7 is a billable, specific ICD-10-CM code for cardiomyopathy due to drug and external agent. It is valid for submission on a claim.

Code first

The underlying condition must be sequenced before this code.

poisoning due to drug or toxin, if applicable (T36-T65 with fifth or sixth character 1-4)

Use additional code

Add a secondary code to capture the detail described below.

code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)

Risk adjustment

I42.7 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

I42.7 is named in 37 Medicare coverage policies — 37 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 I42.7 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 I42.7.

Cardiomyopathy›toxic NEC
Myocardiopathy›toxic NEC
Cardiomyopathy›due to›drugs
Cardiomyopathy›due to›external agents NEC

Related codes at this level

Codes that share I42. If I42.7 is not quite right, the correct code is usually one of these.

Questions about I42.7

Is I42.7 a billable ICD-10-CM code?: Yes. I42.7 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does I42.7 sit in the tabular list?: Diseases of the circulatory system (I00-I99), in the block Other forms of heart disease (I30-I5A).