I43: Cardiomyopathy in diseases classified elsewhere
I43 is a billable, specific ICD-10-CM code for cardiomyopathy in diseases classified elsewhere. It is valid for submission on a claim.
Check I43 with the rest of the claim: free scrubberExcludes1: 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. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
I43 is named in 30 Medicare coverage policies: 30 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)
- A56422Billing and Coding: Bariatric Surgical Management of Morbid Obesity
Code history
Unchanged in every release from FY2024 to FY2027.