I25.5 ICD-10-CM Code: Ischemic cardiomyopathy

Code

I25.5

Description

Ischemic cardiomyopathy

HCC (V28)

No CMS-HCC V28 mapping

RAF reference coefficient

—

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 I25.5 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for I25.5

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for I25.5 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •Documentation must establish ischemic cardiomyopathy, cardiomyopathy attributed to underlying CAD, not non-ischemic causes. The provider typically notes reduced EF on imaging with prior MI or obstructive CAD as the cause, and the narrative links the two.
• •Do not confuse I25.5 with I42.* (non-ischemic cardiomyopathies) or with plain I50.2x systolic HF. I25.5 captures the etiology; pair with the appropriate I50.* code to describe the current heart-failure functional status.
• •This is one of the higher-yield dual-code combinations in MA cardiac charts.

Documentation Requirements

• ✓Documentation of cardiomyopathy with ischemic etiology specified
• ✓Ejection fraction measurement (typically reduced in ischemic cardiomyopathy)
• ✓Evidence of coronary artery disease as the underlying cause (catheterization, history of myocardial infarction, stress testing)
• ✓Exclusion of other cardiomyopathy etiologies (viral, toxic, familial)
• ✓Associated heart failure documentation if present (systolic, diastolic, or combined)

Commonly Confused Codes

• •I42.0: Dilated cardiomyopathy: non-ischemic dilated cardiomyopathy; use when ischemia is NOT the cause
• •I42.9: Cardiomyopathy, unspecified: use only when the etiology cannot be determined
• •I25.10: Atherosclerotic heart disease without angina: coronary artery disease without myocardial dysfunction
• •I50.x: Heart failure codes: often coexist and should be coded separately
• •I43: Cardiomyopathy in diseases classified elsewhere: secondary cardiomyopathy from other causes

Child Codes