I51.4

I51.4: Myocarditis, unspecified

Billable / specific codeICD-10-CM

I51.4 is a billable, specific ICD-10-CM code for myocarditis, unspecified. It is valid for submission on a claim.

Check I51.4 with the rest of the claim: free scrubber

Excludes1: never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

acute or subacute myocarditis (I40.-)

Inclusion terms

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

Chronic (interstitial) myocarditis
Myocardial fibrosis
Myocarditis NOS

Excludes2 inherited from the categories above I51.4

Not part of this code, but both may be coded when both are present.

Written on I51: Complications and ill-defined descriptions of heart disease

heart disease specified as rheumatic (I00-I09)

Other codes that can never be billed with I51.4

Their own Excludes1 notes name this code, so the conflict is not listed above.

I09.0Rheumatic myocarditis

Risk adjustment

I51.4 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. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

I51.4 is named in 10 Medicare coverage policies: 10 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

A52850Billing and Coding: Cardiac Catheterization and Coronary Angiography
A52868Billing and Coding: Transesophageal Echocardiography (TEE)
A56476Billing and Coding: Cardiac Radionuclide Imaging
A56500Billing and Coding: Cardiac Catheterization and Coronary Angiography

Alphabetic index entries that lead here

Acardiotrophia
Myocarditis(with arteriosclerosis)(chronic)(fibroid) (interstitial) (old) (progressive) (senile)
Arteriosclerosis, arteriosclerotic›myocarditis

Code history

Unchanged in every release from FY2024 to FY2027.