I11.0 ICD-10-CM Code: Hypertensive heart disease with heart failure

Code

I11.0

Description

Hypertensive heart disease with heart failure

HCC (V28)

HCC 226 — Heart Failure, Except End Stage and Acute

RAF reference coefficient

0.360

Billable

Yes

Payment year

2026

HCC Category Mapping

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work I11.0 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for I11.0

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, 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

• •Provider must document both hypertension and heart failure, and the ICD-10-CM 'with' convention allows the assumed relationship between them. I11.0 combines HTN and HF; pair with the appropriate I50.* code to identify the HF type per 'use additional code' convention.
• •Do not report I11.0 and I10 together, I11.0 includes the hypertensive disease component. Also, always add the specific I50.* code, otherwise the HF type is lost.
• •Both can be reported together when documentation supports each.

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

• •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)

Child Codes