I13.0 ICD-10-CM Code: Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
I13.0 maps to CMS-HCC V28 226. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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FY 2026 Apr update / Diseases of the circulatory system (I00-I99) / Hypertensive diseases (I10-I1A)
I13.0
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceHypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
High blood pressure that has damaged both the heart and kidneys, with the heart failing to pump effectively and kidney disease in stages 1-4.
Buddy Insight
This combination code captures the triad of hypertension, heart failure, and chronic kidney disease (stages 1-4 or unspecified), representing a complex clinical scenario with significant morbidity.
CMS-HCC V28
MappedHCC 226
Code-level coefficient reference
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 130
Code-level coefficient reference
ESRD/PACE
MappedHCC 85
Code-level coefficient reference
RXHCC
MappedHCC 186
Code-level coefficient reference
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for I13.0. 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
- certain infectious and parasitic diseases (A00-B99)Inherited from I00-I99, I10-I1A
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from I00-I99, I10-I1A
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from I00-I99, I10-I1A
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from I00-I99, I10-I1A
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from I00-I99, I10-I1A
- neoplasms (C00-D49)Inherited from I00-I99, I10-I1A
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from I00-I99, I10-I1A
- systemic connective tissue disorders (M30-M36)Inherited from I00-I99, I10-I1A
- transient cerebral ischemic attacks and related syndromes (G45.-)Inherited from I00-I99, I10-I1A
- hypertensive disease complicating pregnancy, childbirth and the puerperium (O10-O11, O13-O16)Inherited from I00-I99, I10-I1A
Related Codes
Includes
Official- any condition in I11.- with any condition in I12.-Inherited from I13
- cardiorenal diseaseInherited from I13
- cardiovascular renal diseaseInherited from I13
Excludes 1
Official- neonatal hypertension (P29.2)Inherited from I10-I1A
- primary pulmonary hypertension (I27.0)Inherited from I10-I1A
Code First
OfficialNo Code First sequencing instructions are included in this display for I13.0. Check the code and parent instructions in the Code Book.
Use Additional
Official- code to identify type of heart failure (I50.-)
- code to identify stage of chronic kidney disease (N18.1-N18.4, N18.9)
- 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 I13.0. 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 I13.0 an HCC code?
Yes. I13.0 (Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease) maps to HCC 226, Heart Failure, Except End Stage and Acute under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.360. 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: I13.0 is billable and maps to V28 HCC 226, Heart Failure, Except End Stage and Acute. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- I13.0
- Description
- Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
- 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 I13.0 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for I13.0
For I13.0, 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
I13.0 is the ICD-10-CM diagnosis code for hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease. High blood pressure that has damaged both the heart and kidneys, with the heart failing to pump effectively and kidney disease in stages 1-4. I13.0 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, I13.0 maps to Heart Failure, Except End Stage and Acute (HCC 226) with a source-labeled community, non-dual, aged reference coefficient of 0.360. No V24 mapping is shown for I13.0; 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.
Hypertensive heart and chronic kidney disease with heart failure and stage 1-4 CKD, or unspecified. The combination code captures HTN + HF + CKD, all three components must be documented. For I13.0, 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 I13.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Hypertensive heart and chronic kidney disease with heart failure and stage 1-4 CKD, or unspecified. The combination code captures HTN + HF + CKD, all three components must be documented.
- •Do not use I13.0 when CKD is at stage 5 or ESRD, that is I13.2. Also, I13.0 does not replace the need for the specific I50.* and N18.x codes; pair per 'use additional code' convention.
- •I13.0 itself captures HCC 226 (Heart Failure, Except End Stage and Acute). High-yield combination in MA panels.
Clinical Significance
This combination code captures the triad of hypertension, heart failure, and chronic kidney disease (stages 1-4 or unspecified), representing a complex clinical scenario with significant morbidity. Per ICD-10-CM guidelines, when hypertension coexists with both heart failure and CKD, a causal relationship is assumed. This code requires additional codes for both the heart failure type and CKD stage.
Documentation Requirements
- ✓Documented diagnosis of hypertension
- ✓Documented heart failure with type specified (systolic, diastolic, combined)
- ✓Documented chronic kidney disease with stage specified (1-4 or unspecified)
- ✓Additional code from I50.- required for heart failure type
- ✓Additional code from N18.1-N18.4 or N18.9 required for CKD stage
- ✓Ejection fraction and NYHA class when documented
- ✓Current eGFR for CKD staging
- ✓Current treatment regimen addressing all three conditions
Use Additional Code
Commonly Confused Codes
- •I11.0: Hypertensive heart disease with heart failure (use when CKD is NOT present)
- •I12.9: Hypertensive CKD stages 1-4 (use when heart failure is NOT present)
- •I13.10: Hypertensive heart and CKD without heart failure (use when heart disease exists but heart failure does not)
- •I13.2: Hypertensive heart and CKD with heart failure AND stage 5/ESRD (use when CKD is stage 5 or ESRD)
- •I50.x: Heart failure alone (additional code required WITH I13.0, not instead of)