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I50

Non-Billable (Header)

Heart failure

Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)

What This Code Means

I50 is the ICD-10-CM diagnosis code for heart failure. I50 sits in the ICD-10-CM chapter for diseases of the circulatory system (i00-i99), within the section covering other forms of heart disease (i30-i5a).

Header codes like I50 cannot be reported on claims directly — they organize child codes that share clinical context but the actual diagnosis must be coded to the highest level of specificity supported by the documentation. Coders should look at I50's child codes and select the one that matches the patient's documented presentation, since payers reject header codes submitted as the primary diagnosis. For risk adjustment workflows, header codes never contribute to a Medicare Advantage member's RAF score on their own; only billable child codes that happen to map to a payment HCC affect risk-adjusted plan payments.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for I50 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Excludes 2 — Not included here, may code separately

  • cardiac arrest (I46.-)
  • neonatal cardiac failure (P29.0)

Code First

  • heart failure complicating abortion or ectopic or molar pregnancy (O00-O07, O08.8)
  • heart failure due to hypertension (I11.0)
  • heart failure due to hypertension with chronic kidney disease (I13.-)
  • heart failure following surgery (I97.13-)
  • obstetric surgery and procedures (O75.4)
  • rheumatic heart failure (I09.81)

Child Codes

Code Hierarchy

I50Heart failure
I50Heart failure

More on I50

Related condition guides

Referenced in blog posts

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