I50.4 ICD-10-CM Code: Combined systolic (congestive) and diastolic (congestive) heart failure
I50.4 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · free HCC coding tools
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FY 2026 Apr update / Diseases of the circulatory system (I00-I99) / Other forms of heart disease (I30-I5A)
I50.4
Header CodeICD-10-CMOfficial ICD-10-CMCodebook guidanceCombined systolic (congestive) and diastolic (congestive) heart failure
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Combined systolic and diastolic left ventricular heart failure
- Heart failure with reduced ejection fraction and diastolic dysfunction
Excludes 2
Official- certain conditions originating in the perinatal period (P04-P96)Inherited from I00-I99, I50
- certain infectious and parasitic diseases (A00-B99)Inherited from I00-I99, I50
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from I00-I99, I50
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from I00-I99, I50
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from I00-I99, I50
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from I00-I99, I50
- neoplasms (C00-D49)Inherited from I00-I99, I50
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from I00-I99, I50
- systemic connective tissue disorders (M30-M36)Inherited from I00-I99, I50
- transient cerebral ischemic attacks and related syndromes (G45.-)Inherited from I00-I99, I50
- cardiac arrest (I46.-)Inherited from I00-I99, I50
- neonatal cardiac failure (P29.0)Inherited from I00-I99, I50
Related Codes
Includes
OfficialNo Includes notes are included in this display for I50.4. Check the code and parent instructions in the Code Book.
Excludes 1
OfficialNo Excludes 1 notes are included in this display for I50.4. Check the code and parent instructions in the Code Book.
Code First
Official- heart failure complicating abortion or ectopic or molar pregnancy (O00-O07, O08.8)Inherited from I50
- heart failure due to hypertension (I11.0)Inherited from I50
- heart failure due to hypertension with chronic kidney disease (I13.-)Inherited from I50
- heart failure following surgery (I97.13-)Inherited from I50
- obstetric surgery and procedures (O75.4)Inherited from I50
- rheumatic heart failure (I09.81)Inherited from I50
Use Additional
OfficialNo Use Additional Code instructions are included in this display for I50.4. Check the code and parent instructions in the Code Book.
Code Also
Official- end stage heart failure, if applicable (I50.84)
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 →
- Code
- I50.4
- Description
- Combined systolic (congestive) and diastolic (congestive) heart failure
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- Billable
- No
- Payment year
- 2026
Coder workflow notes
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What This Code Means
I50.4 is the ICD-10-CM diagnosis code for combined systolic (congestive) and diastolic (congestive) heart failure. I50.4 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 I50.4 cannot be reported on claims directly; they organize child codes that share clinical context. Coders should select the billable child code that matches the documented presentation and then verify its current source-backed HCC mapping. Do not infer a child code or risk adjustment value from the header alone.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for I50.4 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Code Also
- end stage heart failure, if applicable (I50.84)