I50.811 ICD-10-CM Code: Acute right heart failure
I50.811 maps to CMS-HCC V28 225 (RAF 0.360). Documentation must support MEAT. 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)
I50.811
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceAcute right heart failure
The right side of the heart suddenly fails to pump blood effectively, typically developing over a short period.
Buddy Insight
Acute right heart failure indicates sudden right ventricular dysfunction, often precipitated by acute pulmonary embolism, right ventricular infarction, or acute respiratory distress.
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- Acute isolated right heart failure
- Acute (isolated) right ventricular failure
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for I50.811 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for I50.811 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for I50.811 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for I50.811 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for I50.811 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for I50.811 in this effective period.
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 I50.811 an HCC code?
Yes. I50.811 (Acute right 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: I50.811 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
- I50.811
- Description
- Acute right 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 I50.811 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for I50.811
For I50.811 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 I50.811 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
I50.811 is the ICD-10-CM diagnosis code for acute right heart failure. The right side of the heart suddenly fails to pump blood effectively, typically developing over a short period. I50.811 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, I50.811 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, I50.811 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.
Acute right heart failure. Provider must document acute onset or decompensation of right-sided HF, typically seen in acute PE, RV infarction, or acute cor pulmonale. Because I50.811 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 I50.811 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Acute right heart failure. Provider must document acute onset or decompensation of right-sided HF, typically seen in acute PE, RV infarction, or acute cor pulmonale.
- •Do not code I50.811 at a follow-up visit after the acute episode has resolved, I50.812 (chronic right HF) is the correct follow-up code if right HF persists.
- •V28 HCC 225 (Acute Heart Failure, Excludes Acute on Chronic) at RAF 0.36. Acute right HF maps to the acute-HF HCC, distinct from the chronic-HF HCC 226, though the community coefficient is the same.
Clinical Significance
Acute right heart failure indicates sudden right ventricular dysfunction, often precipitated by acute pulmonary embolism, right ventricular infarction, or acute respiratory distress. This is a medical emergency requiring urgent intervention. The acute designation differentiates from chronic right ventricular failure and impacts treatment urgency.
Documentation Requirements
- ✓Provider must explicitly document 'acute' right heart failure or acute right ventricular failure
- ✓Precipitating cause: pulmonary embolism, right ventricular infarction, acute pulmonary hypertension
- ✓Clinical evidence of acuity: sudden onset symptoms, hemodynamic instability
- ✓Right ventricular function assessment via echocardiogram or other imaging
- ✓Treatment response and clinical trajectory
- ✓Distinction from acute on chronic — implies no pre-existing chronic right heart failure
Commonly Confused Codes
- •I50.813: Acute on chronic right heart failure: use when chronic right heart failure has acute exacerbation
- •I50.812: Chronic right heart failure: long-standing right ventricular dysfunction
- •I50.810: Right heart failure, unspecified: does not specify acuity
- •I26.09: Other pulmonary embolism with acute cor pulmonale: if caused by pulmonary embolism, code the embolism
- •I50.21: Acute systolic heart failure: left-sided, not right-sided failure