Cardiomyopathy G021

Current RMA Instruments:

Changes from Previous Instruments:

ICD Coding

• ICD-10-AM Codes: I42; I43; O90.3

Brief description:

Cardiomyopathy is a group of acquired diseases of the heart muscle leading to mechanical and electrical dysfunction. 

Confirming the diagnosis:

The assessment of this condition is complicated and requires cardiology advice. Investigations may involve echocardiography, electrocardiography and coronary artery angiography/stress testing to exclude other possible diagnoses. 

The relevant medical specialist is a cardiologist.

Additional diagnoses covered by these SOPs

• Alcoholic cardiomyopathy
• Cytotoxic cardiomyopathy
• Dilated cardiomyopathy
• Restrictive cardiomyopathy
• Familial hypertrophic cardiomyopathy
• Idiopathic cardiomyopathy
• Infiltrative cardiomyopathy
• Primary genetic cardiomyopathy
• Radiation cardiomyopathy
• Secondary cardiomyopathy
• Takotsubo (stress) cardiomyopathy
• Myocarditis with persistent mechanical or electrical dysfunction
• Hypertrophic cardiomyopathy
• Arrhythmogenic cardiomyopathy
• Hypertensive cardiomyopathy
• Takotsubo (stress) cardiomyopathy

* This SOP includes genetic cardiomyopathies which do not meet the exclusion criteria

Conditions not covered by these SOPs 

• Cardiac transplant rejection # 
• Myocardial abnormality caused by valvular disease * - Cardiac valve disease SoPs    (Rheumatic heart disease; aortic stenosis)
• Hypertension *
• Infective myocarditis *  (may lead to cardiomyopathy as a sequela)
• Myocardial abnormality caused by ischaemic heart disease * - Ischaemic heart disease SoP
• Pericardial disease including pericarditis *
• Exercise-induced cardiac remodelling (athlete’s heart) #             

* another SOP applies  - the SOP has the same name unless otherwise specified

# non-SOP condition

Clinical onset

Once the diagnosis has been established, the clinical date of onset can be taken from the earliest time in which the individual presented with symptoms and signs consistent with cardiomyopathy and that cannot be attributed to other conditions - chest pain, shortness of breath, swelling in the lower limb, dizziness etc. 

Clinical worsening

The prognosis for cardiomyopathy varies depending on the type, severity and underlying cause(s). With treatment, many people can live and function reasonably well. However, the natural history of cardiomyopathy is to slowly progress and worsen. Any considerations related to possible clinical worsening would need the assessment of a cardiologist to ascertain whether there is a true clinical worsening out of keeping with the natural history of the underlying pathology.