I09.81
I09.81: Rheumatic heart failure
Billable / specific codeICD-10-CM
I09.81 is a billable, specific ICD-10-CM code for rheumatic heart failure. It is valid for submission on a claim.
Check I09.81 with the rest of the claim: free scrubberUse 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. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
I09.81 is named in 13 Medicare coverage policies: 13 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A52850Billing and Coding: Cardiac Catheterization and Coronary Angiography
- A56423Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing
- A56476Billing and Coding: Cardiac Radionuclide Imaging
- A56500Billing and Coding: Cardiac Catheterization and Coronary Angiography
Alphabetic index entries that lead here
- 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)
Code history
Unchanged in every release from FY2024 to FY2027.