I11.0 ICD-10-CM Code: Hypertensive heart disease with heart failure
HCC Buddy Code Card
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FY 2026 Apr update / Diseases of the circulatory system (I00-I99) / Hypertensive diseases (I10-I1A)
I11.0
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceHypertensive heart disease with heart failure
High blood pressure that has caused damage to the heart muscle, resulting in heart failure where the heart cannot pump blood effectively.
Buddy Insight
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.
CMS-HCC V28
MappedHCC 226
RAF 0.360
CMS-HCC V24
MappedHCC 85
RAF 0.331
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 85
RAF 0.0
RXHCC
MappedHCC 186
RAF 0.0
Code Trumping
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Code Book Path
Inclusion Terms
Official- Hypertensive heart failure
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for I11.0 in this effective period.
Related Child Codes
Includes
Official- any condition in I50.- or I51.4-I51.7, I51.89, I51.9 due to hypertension
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for I11.0 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for I11.0 in this effective period.
Use Additional
Official- code to identify type of heart failure (I50.-)
Code Also
OfficialICD-10-CM does not list Code Also instructions for I11.0 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is I11.0 an HCC code?
Yes. I11.0 maps to Heart Failure, Except End Stage and Acute under the CMS-HCC V28 risk adjustment model (and Congestive Heart Failure under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
Work I11.0 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for I11.0
For I11.0to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed I11.0 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
I11.0 is the ICD-10-CM diagnosis code for hypertensive heart disease with heart failure. High blood pressure that has caused damage to the heart muscle, resulting in heart failure where the heart cannot pump blood effectively. I11.0 sits in the ICD-10-CM chapter for diseases of the circulatory system (i00-i99), within the section covering hypertensive diseases (i10-i1a).
Under the CMS-HCC V28 risk adjustment model, I11.0 maps to Heart Failure, Except End Stage and Acute (HCC 226) with a community, non-dual, aged base RAF weight of 0.360. Under the older CMS-HCC V24 model, I11.0 maps to Congestive Heart Failure (HCC 85) with a community, non-dual, aged base RAF weight of 0.331. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
I11.0 requires documentation of both hypertension and heart failure; do not assume heart failure is present without explicit documentation. Because I11.0 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for I11.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
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
Use Additional Code
- code to identify type of heart failure (I50.-)
Commonly Confused Codes
- •I10: Essential hypertension alone (do NOT use when heart failure is also present)
- •I50.1-I50.9: Heart failure codes alone (must be paired with I11.0 when hypertension coexists; I11.0 is sequenced first)
- •I11.9: Hypertensive heart disease WITHOUT heart failure (use when heart disease exists but heart failure does not)
- •I13.0: Hypertensive heart and CKD with heart failure (use when CKD is also present)
- •I09.81: Rheumatic heart failure (different etiology: rheumatic, not hypertensive)