I13.11 ICD-10-CM Code: Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease
I13.11 maps to CMS-HCC V28 326 (RAF 0.815). Documentation must support MEAT. 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)
I13.11
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceHypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease
This code describes a patient who has high blood pressure affecting both the heart and kidneys, with the kidneys in their most severe stage of disease (stage 5/end-stage renal disease), but without heart failure. The patient's kidneys are functioning at less than 15% of normal capacity and typically requires dialysis or transplant.
Buddy Insight
This combination code captures hypertensive heart disease and advanced chronic kidney disease (stage 5 or ESRD) without heart failure.
CMS-HCC V28
MappedHCC 326
RAF 0.815
CMS-HCC V24
MappedHCC 136
RAF 0.289
ACA/HHS
MappedHCC 187
Varies by metal level
ESRD/PACE
MappedHCC 136
RAF 0.000
RXHCC
MappedHCC 187
RAF 0.056
+ HCC 262
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for I13.11 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for I13.11 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for I13.11 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for I13.11 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for I13.11 in this effective period.
Use Additional
Official- code to identify the stage of chronic kidney disease (N18.5, N18.6)
Code Also
OfficialICD-10-CM does not list Code Also instructions for I13.11 in this effective period.
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 I13.11 an HCC code?
Yes. I13.11 (Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease) maps to Chronic Kidney Disease, Stage 5 under the CMS-HCC V28 risk adjustment model (and Chronic Kidney Disease, Stage 5 under V24), with a community non-dual aged RAF of 0.815. It is billable for payment year 2026.
Coder answer: I13.11 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
- I13.11
- Description
- Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease
- HCC (V28)
- HCC 326 — Chronic Kidney Disease, Stage 5
- RAF
- 0.815
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
Each model's RAF is its CMS base weight for that model's standard population, so 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 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 I13.11 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for I13.11
For I13.11 to 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 I13.11 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
I13.11 is the ICD-10-CM diagnosis code for hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease. This code describes a patient who has high blood pressure affecting both the heart and kidneys, with the kidneys in their most severe stage of disease (stage 5/end-stage renal disease), but without heart failure. The patient's kidneys are functioning at less than 15% of normal capacity and typically requires dialysis or transplant. I13.11 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, I13.11 maps to Chronic Kidney Disease, Stage 5 (HCC 326) with a community, non-dual, aged base RAF weight of 0.815. Under the older V24 model, I13.11 mapped to the same category but with a base RAF weight of 0.289, V28 recalibrated weights across the entire model. 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.
Verify documentation confirms both hypertensive heart disease AND chronic kidney disease stage 5/ESRD are present; do not use this code if heart failure is documented. Because I13.11 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 I13.11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation confirms both hypertensive heart disease AND chronic kidney disease stage 5/ESRD are present; do not use this code if heart failure is documented
- •Confirm the specific stage of CKD (stage 5 or ESRD) is documented; if stage 1-4 is present instead, use a different I13 code variant
Clinical Significance
This combination code captures hypertensive heart disease and advanced chronic kidney disease (stage 5 or ESRD) without heart failure. It represents a complex clinical scenario with significant renal impairment requiring dialysis or transplant consideration. The advanced CKD component drives substantial risk adjustment value, making accurate documentation and coding critical.
Documentation Requirements
- ✓Documented diagnosis of hypertension
- ✓Documented heart disease without heart failure
- ✓Documented chronic kidney disease stage 5 or end-stage renal disease
- ✓Additional code N18.5 (stage 5) or N18.6 (ESRD) required
- ✓Current eGFR < 15 mL/min to support stage 5 classification
- ✓Dialysis status if applicable (Z99.2)
- ✓Kidney transplant status if applicable (Z94.0)
- ✓Cardiac evaluation results showing structural heart disease
- ✓Confirmation that heart failure is NOT present
Commonly Confused Codes
- •I13.2: Same conditions but WITH heart failure and stage 5/ESRD (use when heart failure IS present)
- •I13.10: Same conditions but with CKD stages 1-4 (use for earlier CKD stages)
- •I12.0: Hypertensive CKD with stage 5/ESRD (use when heart disease is NOT present)
- •I13.0: Hypertensive heart and CKD with heart failure, stages 1-4 (different CKD stage and HF status)
- •N18.5 / N18.6: CKD stage 5 or ESRD (additional code to use WITH I13.11, not instead of)