Is I42 a billable ICD-10-CM code?

No. I42 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does I42 sit in the tabular list?

Diseases of the circulatory system (I00-I99), in the block Other forms of heart disease (I30-I5A).

I42

I42 — Cardiomyopathy

Non-billable headerICD-10-CM

I42 is a non-billable header ICD-10-CM code for cardiomyopathy. It cannot be billed on its own: choose one of the more specific child codes below.

Excludes2 — not included here, but may coexist

The excluded condition is not part of this code, but a patient can have both. You may code both.

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

Code first

The underlying condition must be sequenced before this code.

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

Includes

Conditions this code covers.

myocardiopathy

Other codes that can never be billed with I42

These codes carry an Excludes1 note pointing at I42. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading I42 alone.

Q24Other congenital malformations of heart
I38Endocarditis, valve unspecified

Risk adjustment

I42 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Code to one of these instead I42

10 child codes. Green means billable.

Questions about I42

Is I42 a billable ICD-10-CM code?: No. I42 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does I42 sit in the tabular list?: Diseases of the circulatory system (I00-I99), in the block Other forms of heart disease (I30-I5A).