I42.6

HCC Category Mapping

What This Code Means

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.

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

Commonly Confused Codes