I43

HCC Category Mapping

What This Code Means

This code is used when the heart muscle becomes weakened or enlarged as a result of another disease or condition that the patient has. It indicates that cardiomyopathy (a problem with the heart's pumping ability) is secondary to another underlying medical condition rather than being a primary heart disease.

Coding Tips

• •This is a secondary diagnosis code that requires documentation of the underlying disease causing the cardiomyopathy; always code the primary condition first
• •Do not use this code for primary cardiomyopathy (I42.-); verify the causal relationship between the documented disease and cardiomyopathy is clearly stated in the medical record

Clinical Significance

Cardiomyopathy in diseases classified elsewhere is a manifestation code indicating that heart muscle disease has developed secondary to another primary condition. Common underlying causes include thyrotoxicosis, hemochromatosis, and metabolic disorders. This code captures the cardiac consequence of systemic disease and must always be paired with the underlying etiology code.

Documentation Requirements

• ✓Provider diagnosis of cardiomyopathy as a manifestation of another disease
• ✓Underlying primary disease documented and coded first
• ✓Causal relationship between the primary disease and cardiomyopathy explicitly stated
• ✓Echocardiographic or other evidence of cardiac dysfunction
• ✓Documentation that the cardiomyopathy is secondary, not primary

Commonly Confused Codes