I50.812 ICD-10-CM Code: Chronic right heart failure
I50.812 maps to CMS-HCC V28 226 (RAF 0.360). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC Buddy coding tools
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Diseases of the circulatory system (I00-I99) / Other forms of heart disease (I30-I5A)
I50.812
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceChronic right heart failure
The right side of the heart has long-term dysfunction and cannot pump blood effectively over an extended period.
Buddy Insight
Chronic right heart failure reflects longstanding right ventricular dysfunction, typically from chronic pulmonary hypertension, chronic lung disease, or chronic left heart failure.
CMS-HCC V28
MappedHCC 226
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- Chronic isolated right heart failure
- Chronic (isolated) right ventricular failure
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for I50.812 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for I50.812 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for I50.812 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for I50.812 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for I50.812 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for I50.812 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 I50.812 an HCC code?
Yes. I50.812 (Chronic right heart failure) 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: I50.812 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
- I50.812
- Description
- Chronic right heart failure
- HCC (V28)
- HCC 226 — Heart Failure, Except End Stage and Acute
- 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 I50.812 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for I50.812
For I50.812 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 I50.812 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
Get the V28 RAF + MEAT cheat sheet
One printable page: confirm a code's V28 HCC status, its RAF weight, and the MEAT your note needs to make it stick. Free, no card.
Free PDF. No card. Unsubscribe anytime.
What This Code Means
I50.812 is the ICD-10-CM diagnosis code for chronic right heart failure. The right side of the heart has long-term dysfunction and cannot pump blood effectively over an extended period. I50.812 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, I50.812 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, I50.812 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.
Chronic right heart failure. Documentation must establish longstanding right-sided HF, typically secondary to chronic pulmonary disease, pulmonary hypertension, or recurrent PE. Because I50.812 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 I50.812 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Chronic right heart failure. Documentation must establish longstanding right-sided HF, typically secondary to chronic pulmonary disease, pulmonary hypertension, or recurrent PE.
- •Do not use I50.812 when acute decompensation is the current issue, I50.813 captures acute-on-chronic right HF. The chronicity descriptor must match the clinical status.
- •V28 HCC 226 at RAF 0.36. Same weight as other I50.* codes; chart accuracy is the lever.
Clinical Significance
Chronic right heart failure reflects longstanding right ventricular dysfunction, typically from chronic pulmonary hypertension, chronic lung disease, or chronic left heart failure. These patients require ongoing management of both the right heart failure and its underlying cause. Annual recapture is important for reflecting the complexity and resource needs of these patients.
Documentation Requirements
- ✓Provider must document 'chronic' right heart failure or chronic right ventricular failure
- ✓Underlying etiology: pulmonary hypertension, chronic obstructive pulmonary disease, left heart failure
- ✓Signs of chronic right heart failure: chronic peripheral edema, hepatomegaly, ascites
- ✓Right ventricular function assessment
- ✓Current treatment plan and monitoring schedule
- ✓Absence of acute exacerbation — if worsening, code I50.813 instead
Commonly Confused Codes
- •I50.813: Acute on chronic right heart failure: use when chronic disease has acute exacerbation
- •I50.811: Acute right heart failure: acute onset without pre-existing chronic disease
- •I50.810: Right heart failure, unspecified: does not specify chronicity
- •I50.814: Right heart failure due to left heart failure: specifically secondary to left heart disease
- •I27.81: Cor pulmonale (chronic): right heart failure specifically secondary to chronic lung disease