I05-I09 — Chronic rheumatic heart diseases
ICD-10-CM codes I05-I09 cover chronic rheumatic heart diseases, within diseases of the circulatory system. The block holds 33 codes across 5 categories, of which 27 are billable and 6 are header codes that cannot be submitted on a claim.
Risk adjustment in I05-I09
0 codes in this block map to a CMS-HCC, which means the diagnosis carries a risk-adjustment payment when it is documented and coded. Under-coding here is money left on the table; over-coding here is what audits are for.
- HCC 226 Heart Failure, Except End Stage and Acute
What else to watch in I05-I09
- 27 codes are named in Medicare coverage policies. An LCD or NCD lists them as supporting medical necessity, or explicitly as not supporting it. Which applies depends on the MAC for your state.