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I50.810 ICD-10-CM Code: Right heart failure, unspecified

I50.810 maps to CMS-HCC V28 226 (RAF 0.360). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC coding software

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FY 2026 Apr update / Diseases of the circulatory system (I00-I99) / Other forms of heart disease (I30-I5A)

I50.810

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Right heart failure, unspecified

The right side of the heart is not functioning properly, but the specific type or severity is not specified in the medical record.

Buddy the Bee presenting code insight

Buddy Insight

Right heart failure, unspecified, indicates the right ventricle cannot effectively pump blood to the lungs for oxygenation.

CMS-HCC V28

HCC 226

RAF 0.360

CMS-HCC V24

HCC 85

RAF 0.331

ACA/HHS

HCC 130

Varies by metal level

ESRD/PACE

HCC 85

RAF 0.063

RXHCC

HCC 186

RAF 0.110

Code Book Path

Official
I50.8Other heart failure
I50.81Right heart failure
I50.810Right heart failure, unspecified

Inclusion Terms

Official
  • Right heart failure without mention of left heart failure
  • Right ventricular failure NOS

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for I50.810 in this effective period.

Related Child Codes

Official
I50.811Acute right heart failure
I50.812Chronic right heart failure
I50.813Acute on chronic right heart failure
I50.814Right heart failure due to left heart failure

Includes

Official

ICD-10-CM does not list Includes notes for I50.810 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for I50.810 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for I50.810 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for I50.810 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for I50.810 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Provider must document right heart failure or right ventricular failure as an active diagnosis
Underlying etiology if known — left heart failure, pulmonary hypertension, chronic obstructive pulmonary disease, pulmonary embolism
Acuity should be specified — this code is used when acute, chronic, or acute on chronic is not documented
Signs and symptoms: peripheral edema, jugular venous distension, hepatomegaly, ascites

MEAT Support

HCC Buddy guidance
Provider must document right heart failure or right ventricular failure as an active diagnosis
Underlying etiology if known — left heart failure, pulmonary hypertension, chronic obstructive pulmonary disease, pulmonary embolism
Acuity should be specified — this code is used when acute, chronic, or acute on chronic is not documented
Signs and symptoms: peripheral edema, jugular venous distension, hepatomegaly, ascites

Audit Caution

HCC Buddy guidance
Using this unspecified code when acuity or underlying cause is documented in the chart
Not querying provider for specificity regarding acuity and etiology
Confusing right heart failure with right ventricular dilation — dilation is a finding, not a diagnosis
Missing the I50.814 code when right failure is documented as secondary to left heart disease

Common Mistakes

HCC Buddy guidance
I50.811 — Acute right heart failure: when documented as acute onset
I50.812 — Chronic right heart failure: when documented as chronic
I50.813 — Acute on chronic right heart failure: when chronic disease has acute exacerbation
I50.814 — Right heart failure due to left heart failure: when right failure is secondary to left heart disease

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 I50.810 an HCC code?

Yes. I50.810 (Right heart failure, unspecified) maps to Heart Failure, Except End Stage and Acute 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: I50.810 is billable and maps to V28 HCC 226, Heart Failure, Except End Stage and Acute. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code
I50.810
Description
Right heart failure, unspecified
HCC (V28)
HCC 226 — Heart Failure, Except End Stage and Acute
RAF
0.360
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 226, Heart Failure, Except End Stage and Acute
0.360
V24HCC 85, Congestive Heart Failure
0.331
ESRDHCC 85, Congestive Heart Failure
0.063
RxHCCHCC 186, Heart Failure
0.110

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 I50.810 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for I50.810

For I50.810 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 I50.810 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

I50.810 is the ICD-10-CM diagnosis code for right heart failure, unspecified. The right side of the heart is not functioning properly, but the specific type or severity is not specified in the medical record. I50.810 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, I50.810 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, I50.810 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.

Right heart failure, unspecified. Documentation must establish isolated right-sided HF without further acute/chronic specification, a chart finding of 'right heart failure' alone supports this unspecified subtype. Because I50.810 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 I50.810 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Right heart failure, unspecified. Documentation must establish isolated right-sided HF without further acute/chronic specification, a chart finding of 'right heart failure' alone supports this unspecified subtype.
  • •Do not default to I50.810 when chronicity is documented, I50.811 (acute), I50.812 (chronic), I50.813 (acute on chronic) are more specific. Also, right HF is clinically distinct from left or biventricular HF; do not substitute I50.2x or I50.3x.
  • •V28 HCC 226 (Heart Failure, Except End Stage and Acute) at RAF 0.36. Right HF shares the HCC with other I50.* codes, the specificity improvement is audit defense and chart quality.

Clinical Significance

Right heart failure, unspecified, indicates the right ventricle cannot effectively pump blood to the lungs for oxygenation. This is often secondary to left heart failure, pulmonary hypertension, or chronic lung disease. Specificity regarding acuity and underlying cause should always be pursued for optimal coding and risk adjustment.

Documentation Requirements

  • ✓Provider must document right heart failure or right ventricular failure as an active diagnosis
  • ✓Underlying etiology if known — left heart failure, pulmonary hypertension, chronic obstructive pulmonary disease, pulmonary embolism
  • ✓Acuity should be specified — this code is used when acute, chronic, or acute on chronic is not documented
  • ✓Signs and symptoms: peripheral edema, jugular venous distension, hepatomegaly, ascites
  • ✓Echocardiographic findings including right ventricular size and function
  • ✓Current treatment plan

Commonly Confused Codes

  • •I50.811: Acute right heart failure: when documented as acute onset
  • •I50.812: Chronic right heart failure: when documented as chronic
  • •I50.813: Acute on chronic right heart failure: when chronic disease has acute exacerbation
  • •I50.814: Right heart failure due to left heart failure: when right failure is secondary to left heart disease
  • •I27.81: Cor pulmonale (chronic): right heart failure specifically due to chronic lung disease

Child Codes

I50.810Right heart failure, unspecified
HCC 226
I50.811Acute right heart failure
HCC 225
I50.812Chronic right heart failure
HCC 226
I50.813Acute on chronic right heart failure
HCC 225
I50.814Right heart failure due to left heart failure
HCC 226

Code Hierarchy

└I50Heart failure└I50.8Other heart failure└I50.81Right heart failure└I50.810Right heart failure, unspecified
└I50.810Right heart failure, unspecified

I50.810 code history

Code setChange
FY2018 (effective Oct 1, 2017)Added to the code set

Source: official CMS ICD-10-CM order and addenda files, FY2016 through FY2027.

Because I50.810 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

I50.810 maps to CMS-HCC V28 category 226, Heart Failure, Except End Stage and Acute. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. Because I50.810 carries a payment HCC, you can see what it adds to a RAF score and check the documentation the chart needs before it is submitted.

More on I50.810

Related condition guides

Referenced in blog posts

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