I27.81 ICD-10-CM Code: Cor pulmonale (chronic)
I27.81 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 · free HCC coding tools
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FY 2026 Apr update / Diseases of the circulatory system (I00-I99) / Pulmonary heart disease and diseases of pulmonary circulation (I26-I28)
I27.81
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceCor pulmonale (chronic)
Chronic heart disease of the right side of the heart caused by long-standing lung disease or pulmonary hypertension.
Buddy Insight
Chronic cor pulmonale represents right ventricular enlargement and failure secondary to chronic lung disease or pulmonary hypertension.
CMS-HCC V28
MappedHCC 226
Coefficient HCC 226: 0.360 (Community Non-Dual Aged (CNA))
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 184
Code-level coefficient reference
Code Book Path
Inclusion Terms
Official- Cor pulmonale NOS
Excludes 2
Official- certain conditions originating in the perinatal period (P04-P96)Inherited from I00-I99
- certain infectious and parasitic diseases (A00-B99)Inherited from I00-I99
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from I00-I99
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from I00-I99
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from I00-I99
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from I00-I99
- neoplasms (C00-D49)Inherited from I00-I99
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from I00-I99
- systemic connective tissue disorders (M30-M36)Inherited from I00-I99
- transient cerebral ischemic attacks and related syndromes (G45.-)Inherited from I00-I99
Related Codes
Includes
OfficialNo Includes notes are included in this display for I27.81. Check the code and parent instructions in the Code Book.
Excludes 1
Official- acute cor pulmonale (I26.0-)
Code First
OfficialNo Code First sequencing instructions are included in this display for I27.81. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for I27.81. Check the code and parent instructions in the Code Book.
Code Also
Official- , if applicable, right heart failure (I50.81-)
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 I27.81 an HCC code?
Yes. I27.81 (Cor pulmonale (chronic)) 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: I27.81 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
- I27.81
- Description
- Cor pulmonale (chronic)
- 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 I27.81 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for I27.81
For I27.81, 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
I27.81 is the ICD-10-CM diagnosis code for cor pulmonale (chronic). Chronic heart disease of the right side of the heart caused by long-standing lung disease or pulmonary hypertension. I27.81 sits in the ICD-10-CM chapter for diseases of the circulatory system (i00-i99), within the section covering pulmonary heart disease and diseases of pulmonary circulation (i26-i28).
Under the CMS-HCC V28 risk adjustment model, I27.81 maps to Heart Failure, Except End Stage and Acute (HCC 226) with a source-labeled community, non-dual, aged reference coefficient of 0.360. 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.
Code the underlying pulmonary condition (such as COPD or pulmonary hypertension) separately. For I27.81, 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 I27.81 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Code the underlying pulmonary condition (such as COPD or pulmonary hypertension) separately
- •This represents the structural and functional changes of the right heart in response to chronic lung disease
Clinical Significance
Chronic cor pulmonale represents right ventricular enlargement and failure secondary to chronic lung disease or pulmonary hypertension. It indicates advanced cardiopulmonary disease with significant mortality risk and high resource utilization. This diagnosis reflects the downstream cardiac consequences of chronic pulmonary disease.
Documentation Requirements
- ✓Provider diagnosis of chronic cor pulmonale
- ✓Evidence of right ventricular hypertrophy or dilation (echocardiogram, cardiac MRI)
- ✓Underlying chronic lung disease or pulmonary hypertension documented
- ✓Symptoms of right heart failure (peripheral edema, jugular venous distention, hepatomegaly)
- ✓Distinction from acute cor pulmonale clearly documented
Excludes 1, Do NOT code together
- acute cor pulmonale (I26.0-)
Code Also
- , if applicable, right heart failure (I50.81-)
Commonly Confused Codes
- •I26.09: Other pulmonary embolism with acute cor pulmonale; this is acute, not chronic
- •I27.0: Primary pulmonary hypertension; a cause of cor pulmonale, not the same entity
- •I50.810: Right heart failure, unspecified; less specific than cor pulmonale
- •I27.23: Pulmonary hypertension due to lung diseases; the hypertension preceding cor pulmonale