I25.10 Does Not Map in V28. Unstable Angina Combo I25.110 Is HCC 229.

If you searched I25.10 next to HCC 229 or V28, you are looking at one of the most common CAD traps under CMS-HCC V28 for payment year 2026. I25.10 is billable atherosclerotic heart disease of a native coronary artery without angina pectoris. It does not map to a CMS-HCC V28 payment HCC.

The unstable-angina combo that does map is I25.110: native CAD with unstable angina pectoris. That code maps to V28 HCC 229 (Unstable Angina and Other Acute Ischemic Heart Disease) with a source-labeled community non-dual aged (CNA) reference of 0.240. Standalone I20.0 (unstable angina without documented ASHD) also maps to HCC 229.

This page is the CAD desk guide for that leak. It is not a rewrite of the I10 hypertensive desk or the V28 PDF list desk.

Desk table: verified maps and no-maps (2026-09-16)

Coefficients are source-labeled CNA references from the live cards and the HCC 229 hub (0.24). Not member totals. Hierarchy still applies: HCC 229 is superseded by HCC 228 (AMI) when both are present.

What I25.10 is (and is not)

I25.10 means atherosclerotic heart disease of a native coronary artery without angina pectoris. Inclusion terms under the I25.1 parent include coronary atherosclerosis, coronary artery disease, and related labels when the chart supports native-vessel disease without current angina.

Billable does not mean risk-adjusted. Under PY2026 community V28 payment, I25.10 has no payment HCC. Do not invent a V24 map for current-year non-PACE scoring. Select the historical period on the live card if you need older model context.

When unstable angina changes the code

If the provider documents native-vessel CAD and unstable angina (new onset, crescendo, or rest angina without infarction), use the combination code I25.110. Do not leave the chart on I25.10. Do not stack I25.10 plus a separate I20.0 when ASHD with unstable angina is documented.

Excludes 1 on I25.110: unstable angina without atherosclerotic heart disease is I20.0. Pick one path from the documentation:

1. Unstable angina with documented native ASHD → I25.110 (HCC 229).

2. Unstable angina without documented ASHD → I20.0 (HCC 229).

3. Native CAD without angina → I25.10 (no V28 payment map).

4. Native CAD with angina that is not unstable (other, unspecified, spasm) → I25.118 / I25.119 / I25.111 (billable, no V28 payment map).

Positive troponins with necrosis move you into acute MI codes (I21.-), not unstable angina. That is a clinical documentation call, not a RAF shortcut.

Other angina combos that do not pay under V28

Coders often assume "any angina with CAD" pulls HCC 229. Under V28 it does not.

Specificity still matters for the claim and the audit trail. It does not create a V28 payment HCC where the file has no row.

Ischemic cardiomyopathy (I25.5)

I25.5 is ischemic cardiomyopathy. Live card and CSV: no V28 payment map. When HF is present, document and code the appropriate I50.- status separately per Tabular instructions and payer rules. Do not treat I25.5 as a stand-in for HCC 229.

MEAT for HCC 229 capture

A mapped code still needs monitoring, evaluation, assessment, or treatment in the eligible encounter year. A problem-list row that says "CAD" or "unstable angina" from last year does not carry HCC 229 forward by itself.

For I25.110 / I20.0, the note should support:

MEAT is a review mnemonic, not a universal CMS coding rule. Follow the applicable coding, encounter, program, and payer requirements. See MEAT and problem lists.

Sequencing and Excludes traps

1. Do not report I20.0 with I25.110 when the combo code already includes unstable angina with native ASHD (Excludes 1).

2. Do not report a separate I20.x angina code next to I25.11x when the combination already bundles the angina component.

3. Code also, when applicable: tobacco exposure or dependence (Z77.22, Z87.891, F17.-, Z72.0), chronic total occlusion (I25.82), lipid-rich plaque (I25.83), calcified lesion (I25.84), and hypertension (I10-I1A) per Use Additional notes on the I20-I25 block.

4. Graft disease lives under I25.7-, not I25.10. Status codes such as Z95.1 (CABG presence) or Z95.5 (angioplasty implant) do not replace the disease code.

5. When AMI (HCC 228) and unstable angina (HCC 229) both appear in the model for the same member, hierarchy supersedes 229.

Common misses

1. Leaving native CAD without angina on I25.10 and expecting HCC 229 because "CAD is an HCC."

2. Coding I25.119 or I25.118 and assuming any angina combo pays under V28. Only I25.110 maps among the native I25.11x family for community V28 payment.

3. Stacking I25.10 + I20.0 instead of using I25.110 when both ASHD and unstable angina are documented.

4. Coding unstable angina when troponin elevation supports NSTEMI / AMI instead.

5. Inventing a V24 payment map for I25.10 on a PY2026 non-PACE score.

6. Treating I25.5 as HCC 229.

7. Skipping MEAT for an acute pattern that resolved months ago with no current assessment.

8. Rewriting this trap into the I10 or V28 PDF desks. Cross-link those posts; keep this CAD walk here.

Two-minute check

1. Is the documentation native CAD without angina? Expect I25.10, no V28 payment map.

2. Is it native CAD with unstable angina and no infarction? Expect I25.110 → HCC 229 (CNA 0.240).

3. Is it unstable angina without ASHD? Expect I20.0 → HCC 229.

4. Is the angina other, unspecified, or spasm with CAD? Expect I25.118 / I25.119 / I25.111, no V28 payment map.

5. Positive biomarkers with necrosis? Look at AMI codes, not UA.

6. MEAT this year. Look the exact code up on its card or /icd10-to-hcc.

Related

Disclaimer

By the HCC Buddy Coding Team. V28 mappings from the cited live code pages, the HCC 229 hub, and `ICD10_CC_mappings_CMS_HCC_2026_v28.csv`, current as of September 16, 2026. Coefficients are source-labeled references, not member totals. Not medical advice. Do not code from this recap. Not a Coding Clinic reprint. Not a rewrite of the I10 hypertensive desk, E13, E66.2, E11.*, L12.0, I70.209, ulcer desks, the V28 PDF list desk, or D59.31.