I11.0

HCC Category Mapping

What This Code Means

High blood pressure that has caused damage to the heart muscle, resulting in heart failure where the heart cannot pump blood effectively.

Coding Tips

• •I11.0 requires documentation of both hypertension and heart failure; do not assume heart failure is present without explicit documentation
• •This code includes hypertensive heart disease with congestive heart failure; specify the type of heart failure if documented

Clinical Significance

Hypertensive heart disease with heart failure represents the combination of hypertension and heart failure, where ICD-10-CM coding guidelines assume a causal relationship between the two conditions. This is a high-value combination code that captures significant clinical complexity. An additional code from I50.- must be assigned to identify the type of heart failure.

Documentation Requirements

• ✓Documented diagnosis of hypertension
• ✓Documented diagnosis of heart failure (systolic, diastolic, or combined)
• ✓Type and severity of heart failure specified (e.g., HFrEF, HFpEF, NYHA class)
• ✓Ejection fraction when available
• ✓Current medication regimen for both hypertension and heart failure
• ✓An additional I50.- code MUST be assigned to specify the type of heart failure
• ✓Note: Per ICD-10 guidelines, when hypertension and heart disease coexist, a causal relationship is assumed unless documentation explicitly states otherwise

Commonly Confused Codes