Coding Cardiomyopathy – A Common Cardiac Condition

by | Published on Nov 24, 2022 | Podcasts, Medical Coding (P) | 0 comments

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A professional, HIPAA compliant medical billing and coding company in the U.S., Outsource Strategies International (OSI) provides quality cardiology coding solutions that help practices maximize their reimbursement. Our medical coders are proficient in CPT, ICD, HCPCS codes and NCCI edits and can assign the most appropriate codes for services rendered.

In today’s podcast, Loralee Kapp, one of our Solutions Managers, discusses Coding Cardiomyopathy – A Common Cardiac Condition.

Podcast Highlights

01:25 Causes of Cardiomyopathy

02:22 Types

03:27 Symptoms

03:58 Cardiomyopathy Diagnosis

04:38 Cardiomyopathy Treatment

Read Transcript

Hey all, this is Loralee Kapp, a Solutions Manager with Managed Outsourced Solutions and today, I wanna go over how to code cardiomyopathy, a chronic cardiac condition.

Cardiomyopathy refers to a progressive disease of the myocardium or heart muscle that makes it harder for the heart to pump blood to the rest of the body. The condition can make the heart chambers enlarged, stretched and thickened, and can cause scar tissue. This affects the heart’s ability to pump blood around the body. In due course, the condition can weaken the heart causing an irregular heartbeat, heart failure, or other complications wherein the heart cannot maintain a normal ejection fraction or cardiac output.

There are different types of cardiomyopathy, caused by a range of factors. If left untreated, the condition can get worse over time causing severe complications like heart failure, blood clots, heart valve problems, cardiac arrest and even sudden death. Treatment modalities include a combination of medications and surgical procedures – which again may depend on the type and severity of cardiomyopathy. Cardiac medical coding can be challenging. Cardiologists and other specialists treating such conditions can rely on the services of a cardiology medical coding company to report the diagnosis and treatments accurately on their medical claims.

01:25 Causes of Cardiomyopathy

According to the National Heart, Lung, and Blood Institute, the exact cause of cardiomyopathy is often unknown. However, in certain cases, it can be the result of another condition (acquired) or inherited. In addition, certain other health conditions can increase the risk of cardiomyopathy. This includes: long-term high blood pressure, usage of some chemotherapy drugs, use of cocaine, amphetamines and anabolic steroids, the growth of granulomas (tiny lumps of inflammatory cells) in any part of the body, the buildup of abnormal proteins in the organs, pregnancy complications, rapid heart rate, metabolic disorders such as obesity, thyroid disease or diabetes, heart valve or heart tissue damage or problems, lack of essential vitamins and minerals in the diet, COVID-19 infection and connective tissue disorders.

02:22 Types

Types of cardiomyopathy include –

  • Dilated cardiomyopathy – Most commonly occurring in middle-aged people, in this type of cardiomyopathy, the heart’s main pumping chamber (the left ventricle) becomes enlarged and can’t effectively pump blood out of the heart.
  • Hypertrophic cardiomyopathy – involves abnormal thickening of the heart muscle, which makes it harder for the heart to work. It can develop at any age, but the condition tends to be more severe if it occurs during childhood.
  • Restrictive cardiomyopathy – is the least common type that can occur at any age, but it most often affects older people. In this type, the heart muscle becomes stiff and less flexible, that makes it difficult to expand and fill with blood between heartbeats.
  • Arrhythmogenic right ventricular dysplasia – This is a rare condition wherein the muscles in the lower right heart chamber (right ventricle) is replaced by scar tissue, and can lead to heart rhythm problems.
  • Unclassified cardiomyopathy – Other types of cardiomyopathy fall into this category.

03:27 Symptoms

In early stages, cardiomyopathy may not depict any specific signs or symptoms. But as the condition advances, signs and symptoms usually appear and these van include –

  • General weakness and fatigue
  • Shortness of breath, particularly during exertion or exercise
  • Lightheadedness or dizziness
  • High blood pressure
  • Heart palpitations
  • Coughing (when lying down)
  • Chest pain
  • A bloated abdomen
  • Edema or swelling of the feet, ankles, legs, or other body parts

03:58 Cardiomyopathy Diagnosis

Cardiologists may begin the diagnosis of cardiomyopathy with a physical examination and detailed medical history review wherein questions will be asked as to when and what types of symptoms occur and what factors may trigger these symptoms. Several other tests and procedures that cardiologists may use to confirm the diagnosis include – blood tests, Chest X-ray, Electrocardiogram (ECG), Echocardiogram, Treadmill stress test, Cardiac catheterization, Cardiac MRI/CT scan, Holter monitor, Coronary angiography, and Myocardial biopsy or genetic testing and screening.

04:38 Cardiomyopathy Treatment

Treatment for cardiomyopathy varies depending on the type and severity of heart damage (whether it is due to cardiomyopathy or the resulting symptoms). Some people may not require treatment until symptoms appear. Other people who struggle with symptoms like chest pain or breathlessness may need to make certain lifestyle changes or take medications. Incorporating a heart-healthy lifestyle change like maintaining a moderate body weight, quitting the habit of smoking, following a balanced and nutritious diet, managing stress and getting the right amount of physical activity can help manage the symptoms. Physicians may prescribe medications to treat high blood pressure, prevent water retention, and keep the heart beating with a normal rhythm, prevent blood clots, or reduce inflammation.

In severe cases of cardiomyopathy, surgery or other procedures may be recommended by cardiologists. Several types of devices can be surgically implanted in the heart to improve its function and relieve symptoms. These include – Implantable cardioverter-defibrillator (ICD), Ventricular assist device (VAD) and Pacemaker. However, if symptoms are severe and medications don’t work well, bypass surgery or valve surgery may be considered an option. However, septal myectomy – a less common procedure, which involves removing some heart tissue to improve blood flow through the heart – may also be suggested. For people with end-stage heart failure, for whom medications and other treatments no longer work, heart transplant may be considered as a last resort.

The diagnoses and treatment procedures administered must be carefully documented using the correct medical codes. Medical billing services provided by a reputable provider can ensure the correct codes on the medical claims.

Cardiomyopathy is a life-threatening condition that can shorten life expectancy if severe damage occurs early on. The disease is also progressive, which means it tends to get worse over time, especially if it isn’t treated. In most cases, cardiomyopathy cannot be fully prevented. However, you can take steps to keep your heart healthy and minimize the impact of this condition. This includes – getting regular exercise, avoiding the use of alcohol and illegal drugs, getting enough sleep, reducing stress, eating a healthy diet and managing underlying health conditions like – high blood pressure, high cholesterol and diabetes.

Clear documentation is important for accurate medical billing process. In order to submit error-free medical claims using the correct medical codes, healthcare practices can rely on services of an experienced medical billing company.

For a full list of ICD-10 codes associated with this podcast, please see the attached document.


I42 Cardiomyopathy

I42.0 Dilated cardiomyopathy

I42.1 Obstructive hypertrophic cardiomyopathy

I42.2 Other hypertrophic cardiomyopathy

I42.3 Endomyocardial (eosinophilic) disease

I42.4 Endocardial fibroelastosis

I42.5 Other restrictive cardiomyopathy

I42.6 Alcoholic cardiomyopathy

I42.7 Cardiomyopathy due to drug and external agent

I42.8 Other cardiomyopathies

I42.9 Cardiomyopathy, unspecified


Loralee Kapp

Since joining our RCM Division in October 2021, Loralee, who is HIT Certified (Health Information Technology/Health Information Management), brings her extensive expertise in medical coding and Health Information Management practices to OSI.

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