I12.0 ICD-10-CM Code: Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
I12.0 maps to CMS-HCC V28 326. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · free HCC coding tools
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FY 2026 Apr update / Diseases of the circulatory system (I00-I99) / Hypertensive diseases (I10-I1A)
I12.0
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceHypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
High blood pressure that has severely damaged the kidneys, resulting in stage 5 chronic kidney disease or end-stage renal disease requiring dialysis or transplant.
Buddy Insight
Hypertensive chronic kidney disease with stage 5 or end-stage renal disease represents the most advanced stage of kidney disease attributed to hypertension.
CMS-HCC V28
MappedHCC 326
Code-level coefficient reference
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 187
Code-level coefficient reference
ESRD/PACE
MappedHCC 136
Code-level coefficient reference
RXHCC
MappedHCC 187
Code-level coefficient reference
+ HCC 262
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for I12.0. Check the code and parent instructions in the Code Book.
Excludes 2
Official- certain conditions originating in the perinatal period (P04-P96)Inherited from I00-I99, I10-I1A, I12
- certain infectious and parasitic diseases (A00-B99)Inherited from I00-I99, I10-I1A, I12
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from I00-I99, I10-I1A, I12
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from I00-I99, I10-I1A, I12
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from I00-I99, I10-I1A, I12
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from I00-I99, I10-I1A, I12
- neoplasms (C00-D49)Inherited from I00-I99, I10-I1A, I12
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from I00-I99, I10-I1A, I12
- systemic connective tissue disorders (M30-M36)Inherited from I00-I99, I10-I1A, I12
- transient cerebral ischemic attacks and related syndromes (G45.-)Inherited from I00-I99, I10-I1A, I12
- hypertensive disease complicating pregnancy, childbirth and the puerperium (O10-O11, O13-O16)Inherited from I00-I99, I10-I1A, I12
- acute kidney failure (N17.-)Inherited from I00-I99, I10-I1A, I12
Related Codes
Includes
Official- any condition in N18 and N26 - due to hypertensionInherited from I12
- arteriosclerosis of kidneyInherited from I12
- arteriosclerotic nephritis (chronic) (interstitial)Inherited from I12
- hypertensive nephropathyInherited from I12
- nephrosclerosisInherited from I12
Excludes 1
Official- neonatal hypertension (P29.2)Inherited from I10-I1A, I12
- primary pulmonary hypertension (I27.0)Inherited from I10-I1A, I12
- hypertension due to kidney disease (I15.0, I15.1)Inherited from I10-I1A, I12
- renovascular hypertension (I15.0)Inherited from I10-I1A, I12
- secondary hypertension (I15.-)Inherited from I10-I1A, I12
Code First
OfficialNo Code First sequencing instructions are included in this display for I12.0. Check the code and parent instructions in the Code Book.
Use Additional
Official- code to identify the stage of chronic kidney disease (N18.5, N18.6)
- code to identify:Inherited from I10-I1A
- exposure to environmental tobacco smoke (Z77.22)Inherited from I10-I1A
- history of tobacco dependence (Z87.891)Inherited from I10-I1A
- occupational exposure to environmental tobacco smoke (Z57.31)Inherited from I10-I1A
- tobacco dependence (F17.-)Inherited from I10-I1A
- tobacco use (Z72.0)Inherited from I10-I1A
Code Also
OfficialNo Code Also instructions are included in this display for I12.0. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is I12.0 an HCC code?
Yes. I12.0 (Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease) maps to HCC 326, Chronic Kidney Disease, Stage 5 under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.815. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: I12.0 is billable and maps to V28 HCC 326, Chronic Kidney Disease, Stage 5. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- I12.0
- Description
- Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
- HCC (V28)
- HCC 326 — Chronic Kidney Disease, Stage 5
- RAF reference coefficient
- 0.815
- 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 I12.0 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for I12.0
For I12.0, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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What This Code Means
I12.0 is the ICD-10-CM diagnosis code for hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease. High blood pressure that has severely damaged the kidneys, resulting in stage 5 chronic kidney disease or end-stage renal disease requiring dialysis or transplant. I12.0 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, I12.0 maps to Chronic Kidney Disease, Stage 5 (HCC 326) with a source-labeled community, non-dual, aged reference coefficient of 0.815. No V24 mapping is shown for I12.0; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
I12.0 is specifically for stage 5 CKD or ESRD; verify the CKD stage is documented as stage 5 before assigning this code. For I12.0, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for I12.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •I12.0 is specifically for stage 5 CKD or ESRD; verify the CKD stage is documented as stage 5 before assigning this code
- •Link the hypertension causally to the kidney disease; do not use if kidney disease is from another cause
Clinical Significance
Hypertensive chronic kidney disease with stage 5 or end-stage renal disease represents the most advanced stage of kidney disease attributed to hypertension. This combination code carries substantial risk adjustment weight, reflecting the extremely high cost and complexity of managing patients with advanced kidney failure requiring dialysis or transplantation alongside chronic hypertension.
Documentation Requirements
- ✓Documented diagnosis of hypertension
- ✓Documented chronic kidney disease stage 5 or end-stage renal disease (ESRD)
- ✓An additional code MUST be assigned to identify the stage of CKD: N18.5 (stage 5) or N18.6 (ESRD)
- ✓Current estimated glomerular filtration rate (eGFR) supporting stage 5 (< 15 mL/min)
- ✓Dialysis status if applicable (Z99.2 for dialysis dependence)
- ✓Kidney transplant status if applicable (Z94.0)
- ✓Current treatment regimen for both hypertension and kidney disease
- ✓Note: Per ICD-10 guidelines, coexistence of hypertension and CKD assumes a causal relationship
Commonly Confused Codes
- •I12.9: Hypertensive CKD with stages 1-4 or unspecified (use for earlier stages of CKD)
- •I13.11: Hypertensive heart and CKD without heart failure, with stage 5/ESRD (use when heart disease is also present)
- •I13.2: Hypertensive heart and CKD with heart failure and stage 5/ESRD (use when heart failure AND heart disease are present)
- •N18.5: Chronic kidney disease stage 5 (additional code to assign WITH I12.0, not instead of)
- •N18.6: End-stage renal disease (additional code to assign WITH I12.0, not instead of)