I50.22 ICD-10-CM Code: Chronic systolic (congestive) heart failure
HCC Buddy Code Card
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FY 2026 Apr update / Diseases of the circulatory system (I00-I99) / Other forms of heart disease (I30-I5A)
I50.22
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceChronic systolic (congestive) heart failure
A long-term condition where the heart's left chamber gradually loses its ability to pump blood effectively, leading to persistent fluid accumulation and fatigue.
Buddy Insight
Chronic systolic congestive heart failure (chronic heart failure with reduced ejection fraction) reflects an ongoing condition requiring lifelong management with guideline-directed medical therapy.
CMS-HCC V28
MappedHCC 226
RAF 0.360
CMS-HCC V24
MappedHCC 85
RAF 0.331
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 85
RAF 0.0
RXHCC
MappedHCC 186
RAF 0.0
Code Trumping
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Code Book Path
Inclusion Terms
Official- Heart failure with reduced ejection fraction [HFrEF]
- Systolic left ventricular heart failure
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for I50.22 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for I50.22 in this effective period.
Excludes 1
Official- combined systolic (congestive) and diastolic (congestive) heart failure (I50.4-)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for I50.22 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for I50.22 in this effective period.
Code Also
Official- end stage heart failure, if applicable (I50.84)
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is I50.22 an HCC code?
Yes. I50.22 maps to Heart Failure, Except End Stage and Acute under the CMS-HCC V28 risk adjustment model (and Congestive Heart Failure under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
Work I50.22 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for I50.22
For I50.22to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.
- 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
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed I50.22 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
I50.22 is the ICD-10-CM diagnosis code for chronic systolic (congestive) heart failure. A long-term condition where the heart's left chamber gradually loses its ability to pump blood effectively, leading to persistent fluid accumulation and fatigue. I50.22 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).
Under the CMS-HCC V28 risk adjustment model, I50.22 maps to Heart Failure, Except End Stage and Acute (HCC 226) with a community, non-dual, aged base RAF weight of 0.360. Under the older CMS-HCC V24 model, I50.22 maps to Congestive Heart Failure (HCC 85) with a community, non-dual, aged base RAF weight of 0.331. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Confirm documentation indicates 'chronic' or 'long-standing' systolic dysfunction. Because I50.22 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. 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, RAF weights, and MEAT documentation criteria for I50.22 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm documentation indicates 'chronic' or 'long-standing' systolic dysfunction
- •Verify this is not an acute exacerbation; if acute worsening occurs, use I50.23 instead
Clinical Significance
Chronic systolic congestive heart failure (chronic heart failure with reduced ejection fraction) reflects an ongoing condition requiring lifelong management with guideline-directed medical therapy. These patients have persistently reduced left ventricular function and are at continued risk for decompensation, arrhythmia, and death. Accurate annual recapture is essential for risk adjustment.
Documentation Requirements
- ✓Provider must document 'chronic' systolic heart failure or chronic heart failure with reduced ejection fraction
- ✓Ejection fraction value, typically less than 40%
- ✓Current guideline-directed medical therapy and compliance status
- ✓New York Heart Association functional class
- ✓Monitoring plan including follow-up schedule and lab monitoring
- ✓Absence of current acute exacerbation — if worsening, code I50.23 instead
Commonly Confused Codes
- •I50.23: Acute on chronic systolic heart failure: use when chronic disease has an acute exacerbation
- •I50.21: Acute systolic heart failure: acute onset without pre-existing chronic disease
- •I50.20: Unspecified systolic heart failure: does not specify chronicity
- •I50.32: Chronic diastolic heart failure: diastolic dysfunction with preserved ejection fraction
- •I50.42: Chronic combined systolic and diastolic heart failure: both systolic and diastolic components documented