Condition guide
Coronary Artery Disease HCC Coding Guide
Stable coronary artery disease (I25.10) does not map to a payment Hierarchical Condition Category under the CMS-HCC V28 model (100% phase-in for payment year 2026), so the most common CAD code adds nothing to a patient's RAF score. Only acute ischemic presentations risk-adjust: CAD with unstable angina (I25.110) and unstable angina (I20.0) map to HCC 229 (Unstable Angina and Other Acute Ischemic Heart Disease), community non-dual aged RAF weight 0.240.
Quick Facts
HCC Categories
HCC 229, Unstable Angina and Other Acute Ischemic Heart Disease
RAF Weight Range
0.240
Community, non-dual, aged (V28)
Model
CMS-HCC V28 (PY2026, 100% phase-in)
3 ICD-10 codes map to payment HCCs
How coders write it
Chart notes, problem lists, and queries rarely spell out Coronary Artery Disease. The shorthand you will actually see:
Whatever the note calls it, the payment question is the same: how the ICD-10-CM code resolves to a payment HCC.
What HCC category does Coronary Artery Disease map to under V28?
Coronary artery disease sits on more Medicare Advantage problem lists than almost any other cardiac diagnosis, and most of it earns nothing in V28 risk adjustment. Stable CAD without angina (I25.10) has never mapped to a payment HCC in either V24 or V28, and neither have old MI (I25.2), ischemic cardiomyopathy (I25.5), or chronic total occlusion (I25.82). What V28 did change is angina: under V24, CAD with stable angina (I25.111, I25.118, I25.119) and angina pectoris alone (I20.9) paid HCC 88, and V28 dropped every one of those codes from payment. The only CAD presentations that risk-adjust under V28 are the acute ischemic ones: CAD with unstable angina (I25.110), unstable angina itself (I20.0), and bypass-graft atherosclerosis with unstable angina (I25.700), all mapping to HCC 229 at a community RAF of 0.240. For coders the frame is simple: document CAD accurately everywhere, but expect RAF movement only from documented acute ischemia, and capture the comorbid conditions that do pay, like heart failure and diabetes.
ICD-10 to HCC Mapping
| ICD-10 Code | Description | Billable | HCC Mapping |
|---|---|---|---|
| I25.10 | Atherosclerotic heart disease of native coronary artery without angina pectoris | Yes | No HCC (not risk-adjusting under V28) |
| I25.110 | Atherosclerotic heart disease of native coronary artery with unstable angina pectoris | Yes | HCC 229 |
| I25.119 | Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris | Yes | No HCC (paid under V24 only, dropped in V28) |
| I25.118 | Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris | Yes | No HCC (paid under V24 only, dropped in V28) |
| I25.111 | Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm | Yes | No HCC (paid under V24 only, dropped in V28) |
| I20.0 | Unstable angina | Yes | HCC 229 |
| I20.9 | Angina pectoris, unspecified | Yes | No HCC (paid under V24 only, dropped in V28) |
| I25.700 | Atherosclerosis of coronary artery bypass graft(s), unspecified, with unstable angina pectoris | Yes | HCC 229 |
| I25.810 | Atherosclerosis of coronary artery bypass graft(s) without angina pectoris | Yes | No HCC (not risk-adjusting under V28) |
| I25.2 | Old myocardial infarction | Yes | No HCC (not risk-adjusting under V28) |
| I25.5 | Ischemic cardiomyopathy | Yes | No HCC (not risk-adjusting under V28) |
| I25.82 | Chronic total occlusion of coronary artery | Yes | No HCC (not risk-adjusting under V28) |
RAF weights are community, non-dual, aged base coefficients from the CMS-HCC V28 model (PY2026). Verify against the latest CMS rate announcement for payment calculations.
HCC Buddy maps Coronary Artery Disease from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coder workflow notes
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Documentation Tips
Document whether angina is present and whether it is stable or unstable at every visit; for native-artery CAD the I25.10 versus I25.11x decision is the whole coding question.
When CAD and unstable angina are both documented, assign the combination code I25.110; the Excludes1 note reserves I20.0 for unstable angina without documented coronary atherosclerosis.
For post-CABG patients, specify whether atherosclerosis involves the native arteries or the grafts; graft disease with angina has its own I25.7xx combination family.
Describe unstable angina in clinical terms the code supports: rest pain, new-onset, crescendo, or accelerating pattern, with the workup and disposition.
Keep documenting history of MI (I25.2) when supported; it does not risk-adjust but it belongs in the record and affects clinical decision-making.
Capture the CAD comorbidities that do carry payment HCCs when documented: heart failure, diabetes, arrhythmias, and peripheral arterial disease.
MEAT documentation examples for Coronary Artery Disease
A diagnosis only counts toward risk adjustment when the encounter note shows the provider engaged with it. These are the kinds of entries that satisfy the MEAT documentation standard for Coronary Artery Disease:
MMonitor
“Lipid panel reviewed: LDL 68 on high-intensity statin.”
“Stress test reviewed: no reversible ischemia.”
“Angina diary reviewed: no episodes since the last visit.”
EEvaluate
“ECG today unchanged from prior; no new Q waves.”
“Post-PCI status reviewed: month 9 of 12 on dual antiplatelet therapy.”
“Chest pain evaluated: exertional, relieved by rest and nitroglycerin, pattern unchanged.”
AAssess
“Stable CAD, status post CABG 2022, asymptomatic.”
“CAD with progressive exertional angina, now limiting daily activity.”
“Unstable angina: rest pain new this week, troponin negative.”
TTreat
“Continue aspirin, atorvastatin 80 mg, and metoprolol.”
“Added ranolazine for refractory angina.”
“Sent to the emergency department for admission; heparin protocol initiated.”
Common Coding Mistakes
Expecting I25.10 to add RAF; it has never mapped to a payment HCC under V24 or V28, and no amount of re-documentation changes that.
Coding unstable angina from a chest-pain rule-out visit; HCC 229 needs documented unstable angina or acute ischemic disease, and it is a natural audit target.
Assigning I20.0 alongside I25.110 for the same event; the Excludes1 note routes documented CAD with unstable angina to the combination code alone.
Working from a V24-era cheat sheet that shows stable angina paying HCC 88; V28 dropped every stable angina code from payment.
V24 to V28 Changes
V28 narrowed ischemic heart disease payment to acute presentations. Under V24, stable angina codes (I25.111, I25.118, I25.119, I20.9) paid HCC 88 (Angina Pectoris, RAF 0.135) and unstable angina paid HCC 87 (RAF 0.195). V28 deleted the stable angina category outright and kept only HCC 229 (Unstable Angina and Other Acute Ischemic Heart Disease, RAF 0.240) for codes like I25.110, I20.0, and I25.700. An actual acute MI codes from I21.x and lands in V28 HCC 228 (Acute Myocardial Infarction, RAF 0.252), which supersedes HCC 229 in the hierarchy. Stable CAD without angina (I25.10), old MI (I25.2), ischemic cardiomyopathy (I25.5), and chronic total occlusion (I25.82) carry no payment HCC in either model, so the transition changed nothing for them.
| Aspect | V24 (through PY2025) | V28 (PY2026) |
|---|---|---|
| Stable CAD without angina (I25.10) | No payment HCC | No payment HCC |
| CAD with stable angina (I25.111, I25.118, I25.119) | HCC 88, Angina Pectoris, RAF 0.135 | No payment HCC |
| Angina pectoris alone (I20.9) | HCC 88, RAF 0.135 | No payment HCC |
| CAD with unstable angina (I25.110, I25.700) | HCC 87, Unstable Angina and Other Acute Ischemic Heart Disease, RAF 0.195 | HCC 229, same label, RAF 0.240 |
| Acute MI (I21.x) | HCC 86, Acute Myocardial Infarction, RAF 0.195 | HCC 228, RAF 0.252 |
| Old MI (I25.2), ischemic cardiomyopathy (I25.5) | No payment HCC | No payment HCC |
RAF values are community, non-dual, aged base coefficients for each model's payment year. To see what these weights do to a real patient total, run the codes through the RAF score calculator.
Coronary Artery Disease coding FAQs
Is coronary artery disease an HCC?
Mostly no under V28. Stable CAD (I25.10), old MI (I25.2), and CAD with stable angina all carry no payment HCC for payment year 2026. Only the acute ischemic codes risk-adjust: I25.110, I20.0, and I25.700 map to HCC 229 with a community, non-dual, aged RAF weight of 0.240. Under V24, stable angina still paid through HCC 88; V28 removed it.
Does I25.10 risk-adjust under V28?
No, and it did not risk-adjust under V24 either. I25.10 (atherosclerotic heart disease of native coronary artery without angina pectoris) has never carried a payment HCC in the CMS-HCC model, despite being the most frequently coded CAD diagnosis. Document it for clinical accuracy, and look to the documented comorbidities, heart failure, diabetes, arrhythmias, for the RAF story.
What is the ICD-10 code for CAD with unstable angina?
I25.110 (atherosclerotic heart disease of native coronary artery with unstable angina pectoris). It maps to V28 HCC 229 with a RAF weight of 0.240. Use I25.110 rather than I20.0 when coronary atherosclerosis is documented; the Excludes1 note limits I20.0 to unstable angina without documented CAD.
Related Conditions
Related references
CMS-HCC V28 model
How the V28 categories, RAF weights, and hierarchy work for PY2026.
ICD-10 to HCC mapping
How an ICD-10-CM code resolves to a payment HCC under V28.
MEAT criteria
The documentation standard every coded condition must satisfy.
Add confirmed HCCs and review the full model total.
Sources
RAF weights are community, non-dual, aged base coefficients from the CMS-HCC V28 model (PY2026). Verify against the latest CMS Rate Announcement for payment.
Verified current to CMS-HCC V28, payment year 2026 — last reviewed July 16, 2026.
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