I13.2
BillableHypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
This code describes a patient who has high blood pressure affecting both the heart and kidneys, with the heart unable to pump blood effectively and the kidneys functioning at less than 15% capacity or requiring dialysis/transplant. This represents the most severe combination of these three conditions occurring together.
Coding Tips
- •This is a combination code that includes hypertension, heart failure, and stage 5 CKD/ESRD - do not code these conditions separately when this combination exists
- •Verify documentation confirms all three components: hypertensive heart disease with heart failure AND stage 5 CKD or ESRD; if only some components are present, use a different I13 subcategory
Clinical Significance
This code represents the most complex hypertensive combination: heart failure, heart disease, and stage 5 CKD or ESRD, all related to hypertension. It reflects extremely high clinical complexity with overlapping cardiac and renal failure requiring intensive, multidisciplinary management. Notably, this code has no direct HCC mapping, but the required additional codes carry significant RAF value.
Documentation Requirements
- ✓Documented diagnosis of hypertension
- ✓Documented heart failure with type specified
- ✓Documented chronic kidney disease stage 5 or end-stage renal disease
- ✓Additional code from I50.- REQUIRED for heart failure type
- ✓Additional code N18.5 or N18.6 REQUIRED for CKD stage
- ✓Ejection fraction and NYHA class when documented
- ✓Current eGFR < 15 mL/min to support stage 5
- ✓Dialysis status (Z99.2) or transplant status (Z94.0) if applicable
- ✓Comprehensive treatment plan addressing cardiac and renal management