I50.84 ICD-10-CM Code: End stage heart failure
I50.84 maps to CMS-HCC V28 222. A source-labeled RAF reference is available. 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)
I50.84
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceEnd stage heart failure
The heart has reached its final stage of failure where it can no longer sustain adequate circulation despite maximum medical therapy, often requiring advanced interventions like transplant or mechanical support.
Buddy Insight
End stage heart failure represents the most severe and terminal form of heart failure where all available medical therapies have been exhausted.
CMS-HCC V28
MappedHCC 222
Code-level coefficient reference
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 130
Code-level coefficient reference
ESRD/PACE
MappedHCC 85
Code-level coefficient reference
RXHCC
MappedHCC 186
Code-level coefficient reference
Code Book Path
Inclusion Terms
Official- Stage D heart failure
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for I50.84 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for I50.84 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for I50.84 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for I50.84 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for I50.84 in this effective period.
Code Also
Official- the type of heart failure as systolic, diastolic, or combined, if known (I50.2-I50.43)
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 I50.84 an HCC code?
Yes. I50.84 (End stage heart failure) maps to HCC 222, End Stage Heart Failure under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 2.505. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: I50.84 is billable and maps to V28 HCC 222, End Stage Heart Failure. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- I50.84
- Description
- End stage heart failure
- HCC (V28)
- HCC 222 — End Stage Heart Failure
- RAF reference coefficient
- 2.505
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work I50.84 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT Criteria for I50.84
For I50.84 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 I50.84 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
I50.84 is the ICD-10-CM diagnosis code for end stage heart failure. The heart has reached its final stage of failure where it can no longer sustain adequate circulation despite maximum medical therapy, often requiring advanced interventions like transplant or mechanical support. I50.84 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, I50.84 maps to End Stage Heart Failure (HCC 222) with a source-labeled community, non-dual, aged reference coefficient of 2.505. No V24 mapping is shown for I50.84; use the applicable model and payment year when reviewing the V28 mapping. 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. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
End stage heart failure. The chart must document end-stage HF, advanced refractory HF, typically Class IV NYHA, often paired with hospice or palliative-care narrative. Because I50.84 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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, source-labeled coefficient references, and MEAT documentation criteria for I50.84 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •End stage heart failure. The chart must document end-stage HF, advanced refractory HF, typically Class IV NYHA, often paired with hospice or palliative-care narrative.
- •Do not use I50.84 casually, this is a specific clinical classification requiring provider documentation of end-stage status. Acute decompensation in a chronically ill patient is not the same as end-stage HF.
- •I50.84 maps to its own end-stage HF HCC and signals advanced disease, often correlating with additional HCCs (frailty indicators) that coders should review.
Clinical Significance
End stage heart failure represents the most severe and terminal form of heart failure where all available medical therapies have been exhausted. These patients are typically being considered for or have been deemed ineligible for heart transplantation or mechanical circulatory support.
Documentation Requirements
- ✓Provider must explicitly document 'end stage' heart failure or equivalent terminology (Stage D heart failure, refractory heart failure)
- ✓Documentation that standard medical therapies have been maximized and are no longer effective
- ✓Advanced therapy evaluation status: transplant candidacy, ventricular assist device consideration
- ✓Functional status — typically New York Heart Association Class IV
- ✓Palliative care or hospice discussions if applicable
- ✓Detailed medication regimen including any intravenous inotropic support
Commonly Confused Codes
- •I50.22: Chronic systolic heart failure: chronic but not end stage: patient still responds to medical therapy
- •I50.23: Acute on chronic systolic heart failure: acute exacerbation, but patient may improve: not necessarily end stage
- •I50.82: Biventricular heart failure: advanced but not specifically end stage
- •I50.9: Heart failure, unspecified: completely nonspecific: never use when end stage is documented
- •Z87.39: Personal history of other diseases of the circulatory system: use only if heart failure has resolved (e.g., post-transplant)