I50.41 ICD-10-CM Code: Acute combined systolic (congestive) and diastolic (congestive) heart failure
I50.41 maps to CMS-HCC V28 225 (RAF 0.360). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC Buddy coding tools
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FY 2026 Apr update / Diseases of the circulatory system (I00-I99) / Other forms of heart disease (I30-I5A)
I50.41
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceAcute combined systolic (congestive) and diastolic (congestive) heart failure
A sudden onset of combined heart failure affecting both the heart's pumping function and its ability to relax, causing acute symptoms and fluid buildup.
Buddy Insight
Acute combined systolic and diastolic congestive heart failure represents a sudden onset of dual ventricular dysfunction where both pumping ability and relaxation are impaired.
CMS-HCC V28
MappedHCC 225
RAF 0.360
CMS-HCC V24
MappedHCC 85
RAF 0.331
ACA/HHS
MappedHCC 130
Varies by metal level
ESRD/PACE
MappedHCC 85
RAF 0.063
RXHCC
MappedHCC 186
RAF 0.110
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
OfficialICD-10-CM does not list Excludes 2 notes for I50.41 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for I50.41 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for I50.41 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for I50.41 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for I50.41 in this effective period.
Code Also
Official- end stage heart failure, if applicable (I50.84)
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 I50.41 an HCC code?
Yes. I50.41 (Acute combined systolic (congestive) and diastolic (congestive) heart failure) maps to Acute Heart Failure (Excludes Acute on Chronic) under the CMS-HCC V28 risk adjustment model (and Congestive Heart Failure under V24), with a community non-dual aged RAF of 0.360. It is billable for payment year 2026.
Coder answer: I50.41 is billable and maps to V28 HCC 225, Acute Heart Failure (Excludes Acute on Chronic). Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- I50.41
- Description
- Acute combined systolic (congestive) and diastolic (congestive) heart failure
- HCC (V28)
- HCC 225 — Acute Heart Failure (Excludes Acute on Chronic)
- RAF
- 0.360
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
Each model's RAF is its CMS base weight for that model's standard population, so 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 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 I50.41 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for I50.41
For I50.41 to 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 I50.41 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
I50.41 is the ICD-10-CM diagnosis code for acute combined systolic (congestive) and diastolic (congestive) heart failure. A sudden onset of combined heart failure affecting both the heart's pumping function and its ability to relax, causing acute symptoms and fluid buildup. I50.41 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, I50.41 maps to Acute Heart Failure (Excludes Acute on Chronic) (HCC 225) with a community, non-dual, aged base RAF weight of 0.360. Under the older CMS-HCC V24 model, I50.41 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.
Verify documentation explicitly states 'acute' combined systolic and diastolic dysfunction. Because I50.41 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 I50.41 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation explicitly states 'acute' combined systolic and diastolic dysfunction
- •Confirm both systolic and diastolic components are documented before assigning this code
Clinical Significance
Acute combined systolic and diastolic congestive heart failure represents a sudden onset of dual ventricular dysfunction where both pumping ability and relaxation are impaired. This represents severe acute cardiac compromise requiring immediate intervention. The combination of both dysfunction types indicates more critical disease than isolated systolic or diastolic failure.
Documentation Requirements
- ✓Provider must document 'acute' combined systolic and diastolic heart failure
- ✓Clinical evidence of acute decompensation with both types of dysfunction
- ✓Echocardiographic evidence of reduced ejection fraction AND diastolic filling abnormalities
- ✓Precipitating factors for the acute event
- ✓Response to acute treatment
- ✓Distinction from acute on chronic — implies no pre-existing chronic combined heart failure
Commonly Confused Codes
- •I50.43: Acute on chronic combined heart failure: use when chronic combined disease has acute exacerbation
- •I50.42: Chronic combined heart failure: use for stable chronic dual dysfunction
- •I50.21: Acute systolic heart failure: only systolic component present
- •I50.31: Acute diastolic heart failure: only diastolic component present
- •I50.40: Unspecified combined heart failure: does not specify acuity