I50.813 ICD-10-CM Code: Acute on chronic right heart failure
I50.813 maps to CMS-HCC V28 225 (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)
I50.813
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceAcute on chronic right heart failure
A patient with long-term right heart failure experiences a sudden worsening or acute episode on top of their chronic condition.
Buddy Insight
Acute on chronic right heart failure represents acute decompensation of longstanding right ventricular dysfunction.
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 on chronic isolated right heart failure
- Acute on chronic (isolated) right ventricular failure
- Acute decompensation of chronic (isolated) right ventricular failure
- Acute exacerbation of chronic (isolated) right ventricular failure
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for I50.813 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for I50.813 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for I50.813 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for I50.813 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for I50.813 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for I50.813 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 I50.813 an HCC code?
Yes. I50.813 (Acute on chronic 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: I50.813 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
- I50.813
- Description
- Acute on chronic 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 I50.813 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for I50.813
For I50.813 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 I50.813 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
I50.813 is the ICD-10-CM diagnosis code for acute on chronic right heart failure. A patient with long-term right heart failure experiences a sudden worsening or acute episode on top of their chronic condition. I50.813 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, I50.813 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, I50.813 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 on chronic right heart failure. The provider must document both longstanding right HF and a current acute decompensation, a dual descriptor in the narrative or assessment. Because I50.813 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 I50.813 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Acute on chronic right heart failure. The provider must document both longstanding right HF and a current acute decompensation, a dual descriptor in the narrative or assessment.
- •Do not use I50.813 for a first episode of right HF, that is I50.811. The 'on chronic' language requires prior documented chronic right HF.
- •V28 HCC 225 (Acute Heart Failure, Excludes Acute on Chronic) at RAF 0.36. Per the V28 crosswalk, acute-on-chronic right HF maps to the acute-HF HCC 225 (not the acute-on-chronic HCC 224 that the systolic and diastolic acute-on-chronic codes carry); both differ from the chronic-HF HCC 226.
Clinical Significance
Acute on chronic right heart failure represents acute decompensation of longstanding right ventricular dysfunction. This typically occurs from worsening pulmonary hypertension, acute respiratory illness, or progression of underlying cardiac disease. These patients require urgent intervention while also managing their chronic disease.
Documentation Requirements
- ✓Documentation must clearly indicate BOTH chronic right heart failure AND acute exacerbation
- ✓Evidence of pre-existing chronic right heart failure
- ✓Evidence of acute worsening: new or increased edema, worsening hepatic congestion, ascites progression
- ✓Precipitating factor for decompensation
- ✓Right ventricular function assessment during acute episode
- ✓Treatment plan for both acute stabilization and chronic management
Commonly Confused Codes
- •I50.811: Acute right heart failure: use only for new onset without chronic history
- •I50.812: Chronic right heart failure: use when stable without acute worsening
- •I50.810: Right heart failure, unspecified: does not specify acuity
- •I50.23: Acute on chronic systolic heart failure: left-sided heart failure
- •I50.814: Right heart failure due to left heart failure: etiology-specific, not acuity-specific