ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 I41

Billable / Specific MCC

Myocarditis in diseases classified elsewhere

I41
Block
0
Synonyms
272
LCDs
12
Payer Policies
0
Linked CPTs

About ICD-10-CM I41

ICD-10-CM code I41 represents Myocarditis in diseases classified elsewhere. This is a billable/specific code in the Circulatory System chapter (block I41). The 2026 edition of ICD-10-CM I41 became effective on October 1, 2025.

Coding Tips for I41

Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.

Inpatient DRG impact: MCC

I41 is designated MCC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-MCC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag MCC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.

Type 1 Excludes

Pure excludes, these codes can never be coded together with I41. The conditions are mutually exclusive (e.g., congenital vs acquired forms).

  • myocarditis (in):
  • Chagas' disease (chronic) (B57.2)
  • acute (B57.0)
  • coxsackie (virus) infection (B33.22)
  • diphtheritic (A36.81)
  • gonococcal (A54.83)
  • influenzal (J09.X9, J10.82, J11.82)
  • meningococcal (A39.52)
  • mumps (B26.82)
  • rheumatoid arthritis (M05.31)
  • sarcoid (D86.85)
  • syphilis (A52.06)
  • toxoplasmosis (B58.81)
  • tuberculous (A18.84)

Coding Notes

Code First

  • underlying disease, such as:
  • typhus (A75.0-A75.9)

Inpatient DRG Impact, MCC

codes Myocarditis in diseases classified elsewhere. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.

Medicare LCD Coverage for I41

Local Coverage Determinations (LCDs) from CMS MACs that list I41 as a covered diagnosis.

272 LCDs

Showing top 10 of 272 total . Click a CPT for full coverage scope.

CMS LCD: Billing and Coding: Transthoracic Echocardiography (TTE)
Article ID: 57306, Effective: 2025-11-06 00:00:00, 1168 covered, 0 non-covered
CPT 93320 →
CMS LCD: Billing and Coding: Transthoracic Echocardiography (TTE)
Article ID: 57306, Effective: 2025-11-06 00:00:00, 1168 covered, 0 non-covered
CPT 76376 →
CMS LCD: Billing and Coding: Transthoracic Echocardiography (TTE)
Article ID: 57306, Effective: 2025-11-06 00:00:00, 1168 covered, 0 non-covered
CPT J0461 →
CMS LCD: Billing and Coding: Transthoracic Echocardiography (TTE)
Article ID: 57306, Effective: 2025-11-06 00:00:00, 1168 covered, 0 non-covered
CPT 93306 →
CMS LCD: Billing and Coding: Transthoracic Echocardiography (TTE)
Article ID: 57306, Effective: 2025-11-06 00:00:00, 1168 covered, 0 non-covered
CPT 93325 →
CMS LCD: Billing and Coding: Transthoracic Echocardiography (TTE)
Article ID: 57306, Effective: 2025-11-06 00:00:00, 1168 covered, 0 non-covered
CPT J2785 →
CMS LCD: Billing and Coding: Transthoracic Echocardiography (TTE)
Article ID: 57306, Effective: 2025-11-06 00:00:00, 1168 covered, 0 non-covered
CPT A9700 →
CMS LCD: Billing and Coding: Transthoracic Echocardiography (TTE)
Article ID: 57306, Effective: 2025-11-06 00:00:00, 1168 covered, 0 non-covered
CPT Q9955 →
CMS LCD: Billing and Coding: Transthoracic Echocardiography (TTE)
Article ID: 57306, Effective: 2025-11-06 00:00:00, 1168 covered, 0 non-covered
CPT 93352 →
CMS LCD: Billing and Coding: Transthoracic Echocardiography (TTE)
Article ID: 57306, Effective: 2025-11-06 00:00:00, 1168 covered, 0 non-covered
CPT J3490 →

Commercial Payer Coverage

Coverage policies from major commercial payers referencing I41.

12 policies

3 Cigna

Ambulatory External and Implantable Electrocardiographic Monitoring - (0547)
Policy ID: MM_0547
Plasma Brain Natriuretic Peptide in the Outpatient Setting - (0028)
Policy ID: MM_0028
Transthoracic Echocardiography in Adults - (0510)
Policy ID: MM_0510

5 Medicare

Billing and Coding: Cardiac Catheterization and Coronary Angiography
Policy ID: ART-52850
Billing and Coding: Cardiac Catheterization and Coronary Angiography
Policy ID: ART-56500
Billing and Coding: Transesophageal Echocardiography (TEE)
Policy ID: ART-56505
Billing and Coding: Computerized Axial Tomography (CT), Thorax
Policy ID: ART-56580
Billing and Coding: Echocardiography
Policy ID: ART-56625

CPT Codes Commonly Billed with I41

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

No procedure linkages on file for I41

We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.

Convert I41 to ICD-9-CM

Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.

ICD-10ICD-9Mapping Flags
I41 4220 10000

Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).

ICD-10 I41, Billing FAQ

Is ICD-10 code I41 billable? +

Yes, I41 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.

What codes are Type 1 Excludes for I41? +

Type 1 Excludes (never code together with I41): myocarditis (in):; Chagas' disease (chronic) (B57.2); acute (B57.0)

Is I41 a CC or MCC for inpatient DRG? +

Yes, this code is designated as MCC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.

What ICD-9 codes does I41 map to? +

Per CMS GEMs, I41 maps to ICD-9 codes: 4220. Useful for legacy data review and historical claim analysis.

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Reviewed by the PayerReady Medical Coding Team

Verified against the CMS 2026 code set on June 1, 2026.

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