I42.5
BillableOther restrictive 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 heart muscle disease where the heart becomes stiff and cannot relax properly, reducing its ability to fill with blood and pump it to the body.
Coding Tips
- •Use this code when restrictive cardiomyopathy is documented but the specific cause is not identified or is not one of the other specified types
- •Ensure documentation clarifies this is restrictive type rather than dilated or hypertrophic cardiomyopathy
Clinical Significance
Other restrictive cardiomyopathy involves stiffening of the heart muscle that impairs ventricular filling, leading to diastolic heart failure. Causes include amyloidosis, sarcoidosis, hemochromatosis, and radiation exposure. This condition carries poor prognosis and high resource utilization with limited treatment options beyond managing the underlying cause.
Documentation Requirements
- ✓Provider diagnosis of restrictive cardiomyopathy
- ✓Echocardiographic or cardiac MRI evidence of restrictive physiology
- ✓Underlying etiology documented if known (amyloidosis, sarcoidosis, hemochromatosis)
- ✓Assessment of diastolic function
- ✓Distinction from constrictive pericarditis documented
Commonly Confused Codes
I42.0 — Dilated cardiomyopathy; enlarged and weakened, different physiologyI42.1 — Obstructive hypertrophic cardiomyopathy; thickened with obstructionI31.1 — Chronic constrictive pericarditis; pericardial rather than myocardial disease, similar presentationI42.3 — Endomyocardial eosinophilic disease; specific type of restrictive disease