I50.9 ICD-10-CM Code: Heart failure, unspecified
I50.9 maps to CMS-HCC V28 226. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. 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)
I50.9
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceHeart failure, unspecified
Heart failure without a specified type or cause. This is used when the heart is unable to pump blood effectively but the specific classification (systolic, diastolic, or combined) is not documented.
Buddy Insight
Heart failure, unspecified, is the least specific heart failure code and should be used only as a last resort when documentation provides no detail about the type, acuity, or affected ventricle.
CMS-HCC V28
MappedHCC 226
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- Cardiac, heart or myocardial failure NOS
- Congestive heart disease
- Congestive heart failure NOS
Excludes 2
Official- fluid overload unrelated to congestive heart failure (E87.70)
- certain conditions originating in the perinatal period (P04-P96)Inherited from I00-I99, I50
- certain infectious and parasitic diseases (A00-B99)Inherited from I00-I99, I50
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from I00-I99, I50
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from I00-I99, I50
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from I00-I99, I50
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from I00-I99, I50
- neoplasms (C00-D49)Inherited from I00-I99, I50
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from I00-I99, I50
- systemic connective tissue disorders (M30-M36)Inherited from I00-I99, I50
- transient cerebral ischemic attacks and related syndromes (G45.-)Inherited from I00-I99, I50
- cardiac arrest (I46.-)Inherited from I00-I99, I50
- neonatal cardiac failure (P29.0)Inherited from I00-I99, I50
Related Codes
Includes
OfficialNo Includes notes are included in this display for I50.9. Check the code and parent instructions in the Code Book.
Excludes 1
OfficialNo Excludes 1 notes are included in this display for I50.9. Check the code and parent instructions in the Code Book.
Code First
Official- heart failure complicating abortion or ectopic or molar pregnancy (O00-O07, O08.8)Inherited from I50
- heart failure due to hypertension (I11.0)Inherited from I50
- heart failure due to hypertension with chronic kidney disease (I13.-)Inherited from I50
- heart failure following surgery (I97.13-)Inherited from I50
- obstetric surgery and procedures (O75.4)Inherited from I50
- rheumatic heart failure (I09.81)Inherited from I50
Use Additional
OfficialNo Use Additional Code instructions are included in this display for I50.9. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for I50.9. Check the code and parent instructions in the Code Book.
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 I50.9 an HCC code?
Yes. I50.9 (Heart failure, unspecified) maps to HCC 226, Heart Failure, Except End Stage and Acute under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.360. 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: I50.9 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
- I50.9
- Description
- Heart failure, unspecified
- HCC (V28)
- HCC 226 — Heart Failure, Except End Stage and Acute
- RAF reference coefficient
- 0.360
- 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 I50.9 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for I50.9
For I50.9, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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What This Code Means
I50.9 is the ICD-10-CM diagnosis code for heart failure, unspecified. Heart failure without a specified type or cause. This is used when the heart is unable to pump blood effectively but the specific classification (systolic, diastolic, or combined) is not documented. I50.9 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, I50.9 maps to Heart Failure, Except End Stage and Acute (HCC 226) with a source-labeled community, non-dual, aged reference coefficient of 0.360. No V24 mapping is shown for I50.9; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. 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.
Documentation must establish heart failure without further specification. I50.9 is the unspecified option; whenever the provider's note supports systolic, diastolic, or combined HF, the more specific I50.2x, I50.3x, or I50.4x code should be selected instead. For I50.9, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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 I50.9 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Documentation must establish heart failure without further specification. I50.9 is the unspecified option; whenever the provider's note supports systolic, diastolic, or combined HF, the more specific I50.2x, I50.3x, or I50.4x code should be selected instead.
- •Do not default to I50.9 when the chart includes an ejection fraction value. An EF < 40% with provider acknowledgment supports systolic HF (I50.2x); preserved EF with HF symptoms supports diastolic HF (I50.3x).
Clinical Significance
Heart failure, unspecified, is the least specific heart failure code and should be used only as a last resort when documentation provides no detail about the type, acuity, or affected ventricle. While it still maps to an HCC in V24, it represents a missed opportunity for more accurate risk stratification and clinical documentation.
Documentation Requirements
- ✓Provider must document heart failure as an active diagnosis
- ✓This code should only be used when documentation does not specify systolic, diastolic, combined, right-sided, or end stage heart failure
- ✓Query the provider for additional specificity before defaulting to this code
- ✓Current medications suggesting heart failure management
- ✓Signs and symptoms of heart failure present during the encounter
- ✓Consider requesting echocardiogram results to determine ejection fraction and type
Excludes 2, Not included here, may code separately
- fluid overload unrelated to congestive heart failure (E87.70)
Commonly Confused Codes
- •I50.1: Left ventricular failure, unspecified: slightly more specific, identifying left ventricle
- •I50.20: Unspecified systolic heart failure: use when systolic dysfunction is documented
- •I50.30: Unspecified diastolic heart failure: use when diastolic dysfunction is documented
- •I50.810: Right heart failure, unspecified: use when right heart failure is specified
- •I50.89: Other heart failure: use for heart failure types not classified elsewhere