2026 ICD-10-CM Diagnosis Code I42.6Alcoholic cardiomyopathy
ICD-10-CM Codes›I00–I99›I30-I5A›I42
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 227
- Chronic Condition
I42.6 is a billable ICD-10-CM diagnosis code for alcoholic cardiomyopathy. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 314 through 316. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 112 closely related codes. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Alcohol-related disorders and Myocarditis and cardiomyopathy.
For Medicare Advantage risk adjustment, I42.6 maps to CMS-HCC Category 227 (Cardiomyopathy/Myocarditis) under the V28 model, adding a risk factor of about 0.189 for a community, non-dual, aged beneficiary in payment year 2026.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
I42.6 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2026.
Source: CMS Payment Year 2026 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Alcoholic cardiomyopathy
- Cardiomyopathy caused by drug
- Dilated cardiomyopathy caused by drug
- Toxic cardiomyopathy
- Toxic dilated cardiomyopathy
Tabular List NotesGuidance
Coding notes and annotation back-references applicable to this code.
Code Also
- presence of alcoholism F10
A "code also" note instructs that two codes may be required to fully describe a condition, but this note does not provide sequencing direction.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Cardiomyopathy (familial) (idiopathic) I42.9
alcoholic I42.6
cobalt-beer I42.6
alcohol I42.6
Disease, diseased See Also: Syndrome;
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Alcohol Use Disorder (AUD)
For most adults, moderate alcohol use is probably not harmful. Your risk of developing an alcohol use disorder (AUD) depends on how much, how often, and how quickly you drink alcohol. Alcohol misuse means that drinking causes distress and harm. Over time alcohol misuse can increase your risk of AUD.
The full article covers:
- What is alcohol use disorder (AUD)?
- What is binge drinking?
- What are the dangers of too much alcohol?
- How do I know if I have an alcohol use disorder (AUD)?
- What should I do if I think that I might have an alcohol use disorder (AUD)?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert I42.6 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About I42.6Overview
What is the ICD-10 code for alcoholic cardiomyopathy?
The ICD-10-CM code for alcoholic cardiomyopathy is I42.6 (sometimes written as I426). It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
Is I42.6 (Cardiomyopathy) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report alcoholic cardiomyopathy on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What MS-DRG does I42.6 group to?
When alcoholic cardiomyopathy is the principal diagnosis on an inpatient stay, it groups to MS-DRG 314, 315, 316, with relative weights from 0.6821 to 2.0852 depending on complications. Higher weights mean higher Medicare reimbursement.
Is I42.6 a CC or MCC?
CMS lists I42.6 as a CC (complication or comorbidity) for FY 2026. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 112 closely related codes in its exclusion list.
What is the ICD-9 equivalent of I42.6?
Under the General Equivalence Mappings, alcoholic cardiomyopathy converts to ICD-9-CM 425.5 (alcoholic cardiomyopathy). The mapping is a direct match.
What HCC is I42.6?
I42.6 (alcoholic cardiomyopathy) maps to CMS-HCC Category 227 (Cardiomyopathy/Myocarditis), commonly written as HCC 227, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2026. It mapped to HCC 85 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. In the Part D prescription drug model it maps to RxHCC 186.
Does I42.6 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, I42.6 adds a risk adjustment factor of about 0.189 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.145 to 0.200 depending on the payment segment). A more severe related category (HCC 221, HCC 222, HCC 223, HCC 224, HCC 225, and HCC 226) supersedes it when both are reported. See the full factor table on the HCC 227 category page.
