What is ICD-10 code I42.6?

I42.6 is the ICD-10-CM diagnosis code for Alcoholic cardiomyopathy. It belongs to the ICD-10-CM chapter for diseases of the circulatory system (i00-i99). I42.6 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. I42.6 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. I42.6 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. I42.6 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does I42.6 map to under V28?

I42.6 maps to CMS-HCC V28 HCC 227 (Cardiomyopathy/Myocarditis). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

What documentation supports I42.6?

Always verify documentation explicitly states alcohol-related cardiomyopathy; do not assume from alcohol use alone without physician confirmation of the causal relationship Consider coding an additional code from category F10 (Alcohol related disorders) to capture the underlying alcohol use disorder when documented, as this provides more complete clinical picture Because I42.6 maps to an HCC category, the documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. See the MEAT criteria checklist at /meat-criteria for what Monitor, Evaluate, Assess, or Treat looks like in a note. MEAT is generic documentation evidence, not a payer-specific rule.

2026 ICD-10-CM I42.6: Alcoholic cardiomyopathy

I42.6 maps to CMS-HCC V28 227. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · free HCC coding tools

ICD-10-CM Code View

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Code lookupI42.6Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the circulatory system (I00-I99) / Other forms of heart disease (I30-I5A)

I42.6

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Alcoholic cardiomyopathy

This is a condition where the heart muscle becomes weakened and enlarged due to excessive alcohol consumption over time, leading to reduced ability to pump blood effectively. It can cause heart failure symptoms like shortness of breath, fatigue, and swelling.

Buddy Insight

Alcoholic cardiomyopathy is a specific form of dilated cardiomyopathy caused by chronic excessive alcohol consumption.

CMS-HCC V28

Mapped

HCC 227

Cardiomyopathy/Myocarditis

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 130

HHS-HCC 130 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 85

Congestive Heart Failure

Code-level coefficient reference

RXHCC

Mapped

HCC 186

Heart Failure

Code-level coefficient reference

Code Book Path

Official

I42Cardiomyopathy

I42.6Alcoholic cardiomyopathy

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for I42.6 in this effective period.

Excludes 2

Official

ischemic cardiomyopathy (I25.5)
peripartum cardiomyopathy (O90.3)
ventricular hypertrophy (I51.7)

Related Child Codes

Official

I42.0Dilated cardiomyopathy

I42.1Obstructive hypertrophic cardiomyopathy

I42.2Other hypertrophic cardiomyopathy

I42.3Endomyocardial (eosinophilic) disease

I42.4Endocardial fibroelastosis

Includes

Official

myocardiopathy

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for I42.6 in this effective period.

Code First

Official

pre-existing cardiomyopathy complicating pregnancy and puerperium (O99.4)

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for I42.6 in this effective period.

Code Also

Official

presence of alcoholism (F10.-)

Buddy Documentation Tip

HCC Buddy guidance

Provider documentation explicitly linking cardiomyopathy to alcohol use

History of chronic alcohol use or alcohol use disorder documented

Echocardiographic findings (left ventricular dilation, reduced ejection fraction)

Exclusion of other cardiomyopathy causes documented

MEAT Support

HCC Buddy guidance

Provider documentation explicitly linking cardiomyopathy to alcohol use

History of chronic alcohol use or alcohol use disorder documented

Echocardiographic findings (left ventricular dilation, reduced ejection fraction)

Exclusion of other cardiomyopathy causes documented

Audit Caution

HCC Buddy guidance

Assuming alcohol-related cardiomyopathy from alcohol use documentation alone without provider confirmation of causal relationship

Not coding the alcohol use disorder (F10 category) separately when documented

Using dilated cardiomyopathy (I42.0) instead when the alcohol etiology is clearly documented

Failing to document the potential for reversibility with alcohol cessation

Common Mistakes

HCC Buddy guidance

I42.0 — Dilated cardiomyopathy; use when the cause is not alcohol-related

I42.7 — Cardiomyopathy due to drug and external agent; for non-alcohol substance-induced cardiomyopathy

F10.20 — Alcohol dependence, uncomplicated; the underlying addiction, code separately

I42.9 — Cardiomyopathy, unspecified; less specific, does not capture the alcohol etiology

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is I42.6 an HCC code?

Yes. I42.6 (Alcoholic cardiomyopathy) maps to HCC 227, Cardiomyopathy/Myocarditis under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.189. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: I42.6 is billable and maps to V28 HCC 227, Cardiomyopathy/Myocarditis. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: I42.6
Description: Alcoholic cardiomyopathy
HCC (V28): HCC 227 — Cardiomyopathy/Myocarditis
RAF reference coefficient: 0.189
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 227, Cardiomyopathy/Myocarditis

0.189

ESRDHCC 85, Congestive Heart Failure

Not separately weighted

RxHCCHCC 186, Heart Failure

Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work I42.6 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for I42.6

For I42.6 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed I42.6 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

I42.6 is the ICD-10-CM diagnosis code for alcoholic cardiomyopathy. This is a condition where the heart muscle becomes weakened and enlarged due to excessive alcohol consumption over time, leading to reduced ability to pump blood effectively. It can cause heart failure symptoms like shortness of breath, fatigue, and swelling. I42.6 sits in the ICD-10-CM chapter for diseases of the circulatory system (i00-i99), within the section covering other forms of heart disease (i30-i5a).

Under the CMS-HCC V28 risk adjustment model, I42.6 maps to Cardiomyopathy/Myocarditis (HCC 227) with a source-labeled community, non-dual, aged reference coefficient of 0.189. No V24 mapping is shown for I42.6; use the applicable model and payment year when reviewing the V28 mapping. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Always verify documentation explicitly states alcohol-related cardiomyopathy; do not assume from alcohol use alone without physician confirmation of the causal relationship. Because I42.6 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for I42.6 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Always verify documentation explicitly states alcohol-related cardiomyopathy; do not assume from alcohol use alone without physician confirmation of the causal relationship
•Consider coding an additional code from category F10 (Alcohol related disorders) to capture the underlying alcohol use disorder when documented, as this provides more complete clinical picture

Clinical Significance

Alcoholic cardiomyopathy is a specific form of dilated cardiomyopathy caused by chronic excessive alcohol consumption. It is partially reversible with alcohol cessation, distinguishing it from other cardiomyopathies. Accurate coding captures both the cardiac disease and the substance use etiology, which affects treatment planning and prognosis.

Documentation Requirements

✓Provider documentation explicitly linking cardiomyopathy to alcohol use
✓History of chronic alcohol use or alcohol use disorder documented
✓Echocardiographic findings (left ventricular dilation, reduced ejection fraction)
✓Exclusion of other cardiomyopathy causes documented
✓Documentation of alcohol cessation counseling and treatment plan

Code Also

presence of alcoholism (F10.-)

Commonly Confused Codes

•I42.0: Dilated cardiomyopathy; use when the cause is not alcohol-related
•I42.7: Cardiomyopathy due to drug and external agent; for non-alcohol substance-induced cardiomyopathy
•F10.20: Alcohol dependence, uncomplicated; the underlying addiction, code separately
•I42.9: Cardiomyopathy, unspecified; less specific, does not capture the alcohol etiology