ICD-10 I11.0
Billable / Specific HCC v28: 85Hypertensive heart disease with heart failure
About ICD-10-CM I11.0
ICD-10-CM code I11.0 represents Hypertensive heart disease with heart failure. This is a billable/specific code in the Circulatory System chapter (block I11). The 2026 edition of ICD-10-CM I11.0 became effective on October 1, 2025.
Coding Tips for I11.0
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
I11.0 is a CMS-HCC v28 risk-adjustment code (category 85). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under I11.0. Per CMS ICD-10-CM Tabular 2026.
- Hypertensive heart failure
Use Additional Code
When coding I11.0, also report these additional codes when applicable.
- code to identify type of heart failure (I50.-)
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Medicare LCD Coverage for I11.0
Local Coverage Determinations (LCDs) from CMS MACs that list I11.0 as a covered diagnosis.
Showing top 10 of 397 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing I11.0.
2 Cigna
5 Medicare
CPT Codes Commonly Billed with I11.0
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 93979 CMS LCD: Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies CMS LCD
- 93975 CMS LCD: Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies CMS LCD
- 93976 CMS LCD: Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies CMS LCD
- 93978 CMS LCD: Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies CMS LCD
- 93980 CMS LCD: Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies CMS LCD
- 93981 CMS LCD: Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies CMS LCD
- 0077U CMS LCD: Billing and Coding: Mass Spectrometry (MS) Testing in Monoclonal Gammopathy (MG) CMS LCD
- 83880 CMS LCD: Billing and Coding: B-type Natriuretic Peptide (BNP) Testing CMS LCD
- 94762 CMS LCD: Billing and Coding: Noninvasive Ear or Pulse Oximetry For Oxygen Saturation CMS LCD
- 94760 CMS LCD: Billing and Coding: Noninvasive Ear or Pulse Oximetry For Oxygen Saturation CMS LCD
Convert I11.0 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| I11.0 | 40201 | 10000 |
| I11.0 | 40211 | 10000 |
| I11.0 | 40291 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To I11.0
Other codes in section I10-I1A (Hypertensive diseases).
ICD-10 I11.0, Billing FAQ
Is ICD-10 code I11.0 billable? +
Yes, I11.0 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to I11.0? +
ICD-10 I11.0 includes: Hypertensive heart failure.
Does I11.0 affect Medicare Advantage HCC risk adjustment? +
Yes. I11.0 maps to CMS-HCC v28 category 85. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with I11.0? +
Procedures frequently paired with I11.0 include: 93979, 93975, 93976, 93978, 93980.
What ICD-9 codes does I11.0 map to? +
Per CMS GEMs, I11.0 maps to ICD-9 codes: 40201, 40211, 40291. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on July 16, 2026.
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