Cardio-Respiratory Failure and Shock
Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 213 carries a community non-dual aged RAF of 0.37, and 36 payable ICD-10-CM diagnosis codes map to it. In the V28 hierarchy it is superseded by HCC 211, HCC 212 when a more severe category in the same disease group is also present.
Medically reviewed by Jess P., CPC · Reviewed: May 30, 2026
RAF factors
The community factor varies by Medicaid and originally-disabled status; the institutional factor applies to long-term-institutional members. These are the CMS-HCC V28 PY2026 relative factors.
Combine this factor with demographics and other HCCs in the RAF score calculator to model the full CMS-HCC V28 RAF for a member.
V28 hierarchy
Trumped by: HCC 211, HCC 212 (a more severe category in the same disease group supersedes this one).
ICD-10-CM codes that map to HCC 213 (36)
Payable diagnosis codes that map to this category under CMS-HCC V28 PY2026. Open any code for its full description, HCC mapping, and coding guidance.
- I46.2Cardiac arrest due to underlying cardiac condition
- I46.8Cardiac arrest due to other underlying condition
- I46.9Cardiac arrest, cause unspecified
- I49.01Ventricular fibrillation
- I49.02Ventricular flutter
- J80Acute respiratory distress syndrome
- J81.0Acute pulmonary edema
- J96.00Acute respiratory failure, unspecified whether with hypoxia or hypercapnia
- J96.01Acute respiratory failure with hypoxia
- J96.02Acute respiratory failure with hypercapnia
- J96.10Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia
- J96.11Chronic respiratory failure with hypoxia
- J96.12Chronic respiratory failure with hypercapnia
- J96.20Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia
- J96.21Acute and chronic respiratory failure with hypoxia
- J96.22Acute and chronic respiratory failure with hypercapnia
- J96.90Respiratory failure, unspecified, unspecified whether with hypoxia or hypercapnia
- J96.91Respiratory failure, unspecified with hypoxia
- J96.92Respiratory failure, unspecified with hypercapnia
- P22.0Respiratory distress syndrome of newborn
- P26.0Tracheobronchial hemorrhage originating in the perinatal period
- P26.1Massive pulmonary hemorrhage originating in the perinatal period
- P26.8Other pulmonary hemorrhages originating in the perinatal period
- P26.9Unspecified pulmonary hemorrhage originating in the perinatal period
- P27.0Wilson-Mikity syndrome
- P27.1Bronchopulmonary dysplasia originating in the perinatal period
- P27.8Other chronic respiratory diseases originating in the perinatal period
- P27.9Unspecified chronic respiratory disease originating in the perinatal period
- P28.0Primary atelectasis of newborn
- P28.10Unspecified atelectasis of newborn
- P28.11Resorption atelectasis without respiratory distress syndrome
- P28.19Other atelectasis of newborn
- P28.5Respiratory failure of newborn
- P29.81Cardiac arrest of newborn
- R57.0Cardiogenic shock
- R57.9Shock, unspecified
Coder workflow notes
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Frequently asked questions
What is CMS-HCC V28 category 213?
HCC 213 is "Cardio-Respiratory Failure and Shock", a payment Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 36 payable ICD-10-CM codes map to it.
What is the RAF weight for HCC 213?
The community non-dual aged relative factor for CMS-HCC V28 category 213 is 0.37. The exact factor varies by enrollment segment (community Medicaid and originally-disabled status, and institutional); the full segment table is published in the CMS V28 Rate Announcement.
How many ICD-10-CM codes map to HCC 213?
36 payable ICD-10-CM diagnosis codes map to CMS-HCC V28 category 213 (Cardio-Respiratory Failure and Shock) for payment year 2026.
Which categories trump HCC 213 in the V28 hierarchy?
HCC 213 is superseded by HCC 211 (Respirator Dependence/Tracheostomy Status/Complications), HCC 212 (Respiratory Arrest). When a more severe category in the same disease group is documented, it is counted instead of HCC 213.
Related condition guides
In-depth HCC coding guides for conditions that map to category 213, with documentation tips, common mistakes, and the V24-to-V28 changes.
Related references
Sources
CMS published ICD-10-CM mapping file plus CMS-HCC v28 PY2026 model software. CMS-HCC V28 model published at CMS.gov Risk Adjustors; ICD-10-CM member codes from the CMS ICD-10-CM code set.
Verified current to CMS-HCC V28, payment year 2026 — last reviewed May 30, 2026.