I09.81 — Rheumatic heart failure
I09.81 is a billable, specific ICD-10-CM code for rheumatic heart failure. It is valid for submission on a claim.
Use additional code
Add a secondary code to capture the detail described below.
- code to identify type of heart failure (I50.-)
Risk adjustment
I09.81 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 226 Heart Failure, Except End Stage and Acute0.360 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.
Medicare coverage
I09.81 is named in 26 Medicare coverage policies — 26 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A52850Billing and Coding: Cardiac Catheterization and Coronary Angiography
- A52850Billing and Coding: Cardiac Catheterization and Coronary Angiography
- A56423Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing
- A56423Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing
How I09.81 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to I09.81.
- Failure, failed›heart›congestive›rheumatic(chronic) (inactive) (with chorea)
- Failure, failed›ventricular›left›rheumatic(chronic) (inactive) (with chorea)
- Fever›rheumatic›inactive or quiescent with›heart failure(congestive) (conditions in category I50.)
- Fever›rheumatic›inactive or quiescent with›left ventricular failure(conditions in I50.1-I50.4-)
- Failure, failed›heart›congestive›with rheumatic fever›inactive or quiescent(with chorea)
- Failure, failed›ventricular›left›with rheumatic fever›inactive or quiescent(with chorea)
Related codes at this level
Codes that share I09.8. If I09.81 is not quite right, the correct code is usually one of these.
Questions about I09.81
- Is I09.81 a billable ICD-10-CM code?
- Yes. I09.81 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does I09.81 sit in the tabular list?
- Diseases of the circulatory system (I00-I99), in the block Chronic rheumatic heart diseases (I05-I09).