What is the ICD-10 (International Classification of Diseases, 10th Revision) code for a family history of cardiac problems?

ICD-10 Code for Family History of Cardiac Problems

Use ICD-10 code Z82.49 for family history of ischemic heart disease and other diseases of the circulatory system when the family history involves unspecified heart disease or multiple cardiovascular conditions. 1

Primary Code Selection

• Z82.49 is the appropriate code for general family history of cardiac problems, covering ischemic heart disease and other circulatory system diseases 1
• Z82.41 should be used specifically when documenting family history of sudden cardiac death in a first-degree relative, particularly if death occurred before age 40 years or was unexplained 1

Specific Clinical Scenarios

For Premature Coronary Artery Disease

• Use Z82.49 when documenting family history of premature coronary artery disease, defined as occurring before age 55 in male relatives or before age 65 in female relatives 2, 1
• This includes first-degree relatives (parents, siblings, children) who experienced angina, acute myocardial infarction, sudden cardiac death, coronary artery bypass surgery, or percutaneous coronary intervention at these ages 2

For Sudden Cardiac Death

• Use Z82.41 when a parent or sibling experienced sudden cardiac death, defined as natural death due to cardiac causes with abrupt loss of consciousness 2, 1
• Document the age at time of sudden cardiac death, as this affects risk stratification 2

For Specific Cardiomyopathies

• Z82.49 applies to family history of cardiomyopathy (dilated, hypertrophic, or arrhythmogenic right ventricular dysplasia) in one or more first-degree relatives 2
• Document whether the cardiomyopathy was with or without obstruction, and specify etiology if known 2

Documentation Requirements for Medical Necessity

The exact nature of the family history must be documented to support medical necessity, including: 1

• Which first-degree relatives are affected (parent, sibling, child) 2, 1
• Age at diagnosis or death of affected relatives 2, 1
• Specific cardiac conditions if known (angina, MI, sudden death, bypass surgery, percutaneous intervention) 2, 1

Clinical Significance and Risk Assessment

• Family history of premature cardiovascular disease confers a 1.5- to 2.0-fold increased risk even after adjusting for traditional risk factors 2, 1
• Risk strength increases with younger age of onset in relatives, increasing numbers of affected relatives, and closer genealogical proximity 2, 1
• These codes (Z82.49 or Z82.41) establish medical necessity for screening echocardiography, electrocardiography, and stress testing 1

Additional Family History Codes to Consider

Other Cardiac-Related Family History

• Family history of muscular dystrophy should be documented separately, as it can be associated with cardiomyopathy 2
• Family history of conduction system disease (early onset atrial or ventricular arrhythmias) warrants specific documentation 2
• Family history of hypertrophic cardiomyopathy may be specified separately if known 2

Common Pitfalls to Avoid

• Do not use unspecified codes when specific information about sudden cardiac death or premature coronary disease is available 1
• Do not fail to document the age of affected relatives, as this is critical for risk stratification (age <55 for males, <65 for females defines "premature") 2
• Do not overlook second-degree relatives entirely, though first-degree relatives carry the most significant risk 2
• Verify the reliability of self-reported family history when possible, as positive predictive value for validated events is only 28-66%, though negative predictive value is excellent at 90-96% 2