I43
I43 — Cardiomyopathy in diseases classified elsewhere
Billable / specific codeICD-10-CM
I43 is a billable, specific ICD-10-CM code for cardiomyopathy in diseases classified elsewhere. It is valid for submission on a claim.
Excludes1 — never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
Code first
The underlying condition must be sequenced before this code.
Risk adjustment
I43 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
I43 is named in 41 Medicare coverage policies — 41 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
Questions about I43
- Is I43 a billable ICD-10-CM code?
- Yes. I43 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does I43 sit in the tabular list?
- Diseases of the circulatory system (I00-I99), in the block Other forms of heart disease (I30-I5A).
- What cannot be coded together with I43?
- I43 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.