I11.9 ICD-10-CM Code: Hypertensive heart disease without heart failure
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FY 2026 Apr update / Diseases of the circulatory system (I00-I99) / Hypertensive diseases (I10-I1A)
I11.9
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceHypertensive heart disease without heart failure
High blood pressure that has caused structural or functional damage to the heart, but without resulting in heart failure.
Buddy Insight
Hypertensive heart disease without heart failure captures cardiac disease (such as left ventricular hypertrophy, diastolic dysfunction, or other cardiac structural changes) attributed to chronic hypertension, but without the presence of heart failure.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
MappedHCC 187
RAF 0.0
Code Trumping
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Code Book Path
Inclusion Terms
Official- Hypertensive heart disease NOS
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for I11.9 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 I11.9 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for I11.9 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for I11.9 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for I11.9 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 I11.9 an HCC code?
No. I11.9 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
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 I11.9 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for I11.9
For I11.9to 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 I11.9 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
I11.9 is the ICD-10-CM diagnosis code for hypertensive heart disease without heart failure. High blood pressure that has caused structural or functional damage to the heart, but without resulting in heart failure. I11.9 sits in the ICD-10-CM chapter for diseases of the circulatory system (i00-i99), within the section covering hypertensive diseases (i10-i1a).
I11.9 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
This code does not map to a CMS-HCC V28 payment category. Capture depends on documentation that supports the diagnosis; verify the HCC assignment against the current CMS mapping for the applicable payment year. Coders reviewing I11.9 should check whether additional documentation would support a more specific child code in the same hierarchy that does map to a payment HCC, capturing the correct specificity is the highest-impact RAF improvement available within accurate coding.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for I11.9 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use I11.9 when hypertensive heart disease is documented without heart failure symptoms or findings
- •This includes left ventricular hypertrophy and other cardiac changes from chronic hypertension without heart failure
Clinical Significance
Hypertensive heart disease without heart failure captures cardiac disease (such as left ventricular hypertrophy, diastolic dysfunction, or other cardiac structural changes) attributed to chronic hypertension, but without the presence of heart failure. While this condition does not carry CMS-HCC weight, it represents an important clinical distinction from hypertensive heart failure.
Documentation Requirements
- ✓Documented diagnosis of hypertension
- ✓Documented cardiac disease attributed to or coexisting with hypertension (e.g., left ventricular hypertrophy, cardiomegaly)
- ✓Explicit statement that heart failure is NOT present, or absence of heart failure documentation
- ✓Echocardiographic or other cardiac imaging findings when available
- ✓Current antihypertensive medication regimen
- ✓Note: Per ICD-10 guidelines, coexistence of hypertension and heart disease assumes a causal relationship
Commonly Confused Codes
- •I10: Essential hypertension without heart disease (use when no cardiac disease is documented)
- •I11.0: Hypertensive heart disease WITH heart failure (use when heart failure IS present)
- •I13.10: Hypertensive heart and CKD without heart failure (use when CKD is also present)
- •I51.7: Cardiomegaly (would be encompassed by I11.9 when hypertension coexists)
- •I51.81: Takotsubo syndrome (separate condition, not hypertensive heart disease)