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FY2027 ICD-10-CM reference

I43: Cardiomyopathy in diseases classified elsewhere

By the HCC Buddy Coding Team

The official ICD-10-CM descriptor is Cardiomyopathy in diseases classified elsewhere. The FY2027 annual edition starts October 1, 2026. Check the edition that applies to the encounter or inpatient discharge, including any April update.

Billable code. Verified against the official FY2027 order file.

Oct to Dec 2026, PY2027

CMS-HCC V28

Mapped

HCC 227Cardiomyopathy/MyocarditisCoefficient 0.189 (CNA, PY2027)

CMS-HCC V24

Not used by CMS

CMS published no community V24 for PY2027 (CMS CY2027 Rate Announcement p3 l6-8: the 2024 CMS-HCC model only; the 2027 Initial mappings carry no community V24 column)

ESRD

Mapped

HCC 85Congestive Heart FailureCoefficient 0.063 (Dialysis CE, PY2027)

RxHCC

Mapped

HCC 186Heart FailureCoefficient 0.163 (MA-PD CE non-low aged, PY2027)

PACE (CMS-HCC V22 component)

Mapped

HCC 85Congestive Heart Failure

PACE ESRD (ESRD V21 component)

Mapped

HCC 85Congestive Heart Failure

PACE RxHCC (2018/2019 component)

Mapped

HCC 186Heart Failure

Jan to Sep 2027, PY2028

CMS-HCC V28

Not published by CMS

Not published by CMS for PY2028. (No CY2028 Advance Notice or Rate Announcement on cms.gov as of 2026-11-02)

CMS-HCC V24

Not published by CMS

Not published by CMS for PY2028. (No CY2028 Advance Notice or Rate Announcement on cms.gov as of 2026-11-02)

ESRD

Not published by CMS

Not published by CMS for PY2028. (No CY2028 Advance Notice or Rate Announcement on cms.gov as of 2026-11-02)

RxHCC

Not published by CMS

Not published by CMS for PY2028. (No CY2028 Advance Notice or Rate Announcement on cms.gov as of 2026-11-02)

PACE (CMS-HCC V22 component)

Not published by CMS

Not published by CMS for PY2028. (No CY2028 Advance Notice or Rate Announcement on cms.gov as of 2026-11-02)

PACE ESRD (ESRD V21 component)

Not published by CMS

Not published by CMS for PY2028. (No CY2028 Advance Notice or Rate Announcement on cms.gov as of 2026-11-02)

PACE RxHCC component

Not published by CMS

Not published by CMS for PY2028. (No CY2028 Advance Notice or Rate Announcement on cms.gov as of 2026-11-02)

Oct to Dec 2026, BY2026

HHS-HCC

Pending

CMS has not published FY2027 code validity for BY2026 HHS-HCC (Table 3 update pending). Mapping pending. (CMS CY2026 DIY instructions p8 l39-45: FY2027 code information for October 1 to December 31, 2026 service dates is not in Table 3 yet; valid_ICD10_2027 is blank on all 12,667 rows)

Jan to Sep 2027, BY2027

HHS-HCC

Not published by CMS

Not published by CMS for BY2027. (CMS-9883-F (2026-05-15) finalizes BY2027 factors (NBPP 2027 p53 l17-21); CMS has posted no BY2027 DIY Table 3 as of 2026-11-02)

FY2027 Tabular instructions

Instructions below include applicable chapter, section and parent-code notes. Each note identifies where it appears in the official source.

Excludes2

certain conditions originating in the perinatal period (P04-P96)

Source: I00-I99 (chapter, inherited).

Excludes2

certain infectious and parasitic diseases (A00-B99)

Source: I00-I99 (chapter, inherited).

Excludes2

complications of pregnancy, childbirth and the puerperium (O00-O9A)

Source: I00-I99 (chapter, inherited).

Excludes2

congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)

Source: I00-I99 (chapter, inherited).

Excludes2

endocrine, nutritional and metabolic diseases (E00-E88)

Source: I00-I99 (chapter, inherited).

Excludes2

injury, poisoning and certain other consequences of external causes (S00-T88)

Source: I00-I99 (chapter, inherited).

Excludes2

neoplasms (C00-D49)

Source: I00-I99 (chapter, inherited).

Excludes2

symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)

Source: I00-I99 (chapter, inherited).

Excludes2

systemic connective tissue disorders (M30-M36)

Source: I00-I99 (chapter, inherited).

Excludes2

transient cerebral ischemic attacks and related syndromes (G45.-)

Source: I00-I99 (chapter, inherited).

Code first

underlying disease, such as:

Source: I43 (category, direct).

Code first

amyloidosis (E85.-)

Source: I43 (category, direct).

Code first

glycogen storage disease (E74.0-)

Source: I43 (category, direct).

Code first

gout (M10.0-)

Source: I43 (category, direct).

Code first

thyrotoxicosis (E05.0-E05.9-)

Source: I43 (category, direct).

Excludes1

cardiomyopathy (in):

Source: I43 (category, direct).

Excludes1

coxsackie (virus) (B33.24)

Source: I43 (category, direct).

Excludes1

diphtheria (A36.81)

Source: I43 (category, direct).

Excludes1

sarcoidosis (D86.85)

Source: I43 (category, direct).

Excludes1

tuberculosis (A18.84)

Source: I43 (category, direct).

Source: CMS FY2027 Tabular List and Alphabetic Index.

Open Tabular instructions and code details

Compare the FY2027 additions, removals and billable-status changes

What does I43 mean in FY2027?

The official ICD-10-CM descriptor is Cardiomyopathy in diseases classified elsewhere. The FY2027 annual edition starts October 1, 2026. Check the edition that applies to the encounter or inpatient discharge, including any April update.

Is I43 billable in FY2027?

The FY2027 order file marks I43 as billable. Check the complete Tabular instructions and documentation before assigning it.

Does I43 map to an HCC?

Oct to Dec 2026, PY2027: CMS-HCC V28 HCC 227 (Cardiomyopathy/Myocarditis); CMS-HCC V24: Not used by CMS; ESRD HCC 85 (Congestive Heart Failure); RxHCC HCC 186 (Heart Failure). Jan to Sep 2027, PY2028: CMS-HCC V28: Not published by CMS; CMS-HCC V24: Not published by CMS; ESRD: Not published by CMS; RxHCC: Not published by CMS. Oct to Dec 2026, BY2026: HHS-HCC: Pending. Jan to Sep 2027, BY2027: HHS-HCC: Not published by CMS. Base coefficients are reference values, not a member total.

Source: CMS FY2027 ICD-10-CM order file. Payment model: CMS CY 2027 Rate Announcement. Read the FY2027 Official Guidelines.

Review the FY2026 April edition