I11.0: Hypertensive heart disease with heart failure
I11.0 is a billable, specific ICD-10-CM code for hypertensive heart disease with heart failure. It is valid for submission on a claim.
Check I11.0 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.-)
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Hypertensive heart failure
Other codes that can never be billed with I11.0
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
I11.0 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
I11.0 is named in 29 Medicare coverage policies: 29 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A52850Billing and Coding: Cardiac Catheterization and Coronary Angiography
- A53026Billing and Coding: Bariatric Surgery Coverage
- A54923Billing and Coding: Bariatric Surgery for Treatment of Co-Morbidities Conditions Related to Morbid Obesity
- A56423Billing and Coding: Cardiology Non-emergent Outpatient Stress Testing
Alphabetic index entries that lead here
- Hypertension, hypertensive›with›heart failure(congestive)
- Hypertension, hypertensive›heart›with›heart failure(congestive)
The condition this code belongs to
Code history
Unchanged in every release from FY2024 to FY2027.