I13.2 ICD-10-CM Code: Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
I13.2 maps to CMS-HCC V28 HCCs 226 and 326. Source-labeled RAF references are 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)
I13.2
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceHypertensive heart and chronic kidney disease with heart failure and 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 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.
Buddy Insight
This code represents the most complex hypertensive combination: heart failure, heart disease, and stage 5 CKD or ESRD, all related to hypertension.
CMS-HCC V28
MappedHCC 226
Code-level coefficient reference
+ HCC 326
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 130
Code-level coefficient reference
+ HCC 187
ESRD/PACE
MappedHCC 85
Code-level coefficient reference
+ HCC 136
RXHCC
MappedHCC 186
Code-level coefficient reference
+ HCC 262
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for I13.2. 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 I13.2. Check the code and parent instructions in the Code Book.
Use Additional
Official- code to identify type of heart failure (I50.-)
- 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 I13.2. 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 I13.2 an HCC code?
Yes. I13.2 (Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease) maps to HCC 226, Heart Failure, Except End Stage and Acute and HCC 326, Chronic Kidney Disease, Stage 5 under the CMS-HCC V28 risk adjustment model, with source-labeled community non-dual aged reference coefficients HCC 226 0.360 and HCC 326 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: I13.2 is billable and maps to V28 HCC 226, Heart Failure, Except End Stage and Acute and HCC 326, Chronic Kidney Disease, Stage 5. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- I13.2
- Description
- Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease
- HCC (V28)
- HCC 226 — Heart Failure, Except End Stage and Acute; HCC 326 — Chronic Kidney Disease, Stage 5
- RAF reference coefficient
- HCC 226: 0.360; HCC 326: 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 I13.2 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for I13.2
For I13.2, 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
I13.2 is the ICD-10-CM diagnosis code for hypertensive heart and chronic kidney disease with heart failure and 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 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. I13.2 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, I13.2 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 I13.2; 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 CKD with heart failure and stage 5 CKD or ESRD. All three components, HTN, HF, ESRD/stage 5 CKD, must be documented. For I13.2, 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 I13.2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Hypertensive heart and CKD with heart failure and stage 5 CKD or ESRD. All three components, HTN, HF, ESRD/stage 5 CKD, must be documented.
- •Do not use I13.2 when CKD is at stage 4 or below, I13.0 is the correct choice. Also pair I13.2 with N18.5 or N18.6 plus Z99.2 when dialysis-dependent, and with the specific I50.* code.
- •The official CY2026 final mapping lists V28 HCC 226 and HCC 326 for I13.2. Follow the tabular 'use additional code' instructions for the specific I50.* and N18.* diagnoses, then apply hierarchy rules and member-segment coefficients to the complete diagnosis set.
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.
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
Use Additional Code
Commonly Confused Codes
- •I13.0: Hypertensive heart and CKD with HF, stages 1-4 (use for earlier CKD stages)
- •I13.11: Hypertensive heart and CKD without HF, stage 5/ESRD (use when heart failure is NOT present)
- •I11.0: Hypertensive heart disease with HF (use when CKD is NOT present)
- •I12.0: Hypertensive CKD with stage 5/ESRD (use when heart disease is NOT present)
- •I50.x + N18.6: These are additional codes that must be assigned WITH I13.2, not as replacements