I42.0
BillableDilated cardiomyopathy
HCC Category Mapping
V28HCC 227 — Cardiomyopathy
0.339V24HCC 85 — Congestive Heart Failure
0.368ESRDHCC 85 — Congestive Heart Failure
0.000RxHCCHCC 186 — Heart Failure
0.000What This Code Means
A condition where the heart muscle becomes enlarged and weakened, reducing the heart's ability to pump blood effectively throughout the body.
Coding Tips
- •Document the ejection fraction percentage when available, as it affects severity assessment and treatment decisions
- •Identify any known etiology (ischemic, idiopathic, viral) to support medical necessity
Clinical Significance
Dilated cardiomyopathy is a condition where the heart's main pumping chamber is enlarged and weakened, leading to reduced ejection fraction and heart failure. It is a leading indication for heart transplantation and carries significant mortality risk. Accurate coding reflects high resource utilization including heart failure medications, device therapy, and transplant evaluation.
Documentation Requirements
- ✓Provider diagnosis of dilated cardiomyopathy
- ✓Echocardiographic findings showing ventricular dilation and reduced systolic function
- ✓Left ventricular ejection fraction documented
- ✓Etiology if known (idiopathic, familial, viral, ischemic distinction)
- ✓Current heart failure management (medications, device therapy such as implantable cardioverter defibrillator or cardiac resynchronization therapy)
Commonly Confused Codes
I42.1 — Obstructive hypertrophic cardiomyopathy; thickened not dilated ventricleI42.9 — Cardiomyopathy, unspecified; use only when the type cannot be determinedI50.20 — Unspecified systolic (systolic) heart failure; a consequence, not the cardiomyopathy itselfI25.5 — Ischemic cardiomyopathy; use when the dilated cardiomyopathy is due to coronary artery disease