ICD-10 I16.1
Billable / Specific CCHypertensive emergency
About ICD-10-CM I16.1
ICD-10-CM code I16.1 represents Hypertensive emergency. This is a billable/specific code in the Circulatory System chapter (block I16). The 2026 edition of ICD-10-CM I16.1 became effective on October 1, 2025.
Coding Tips for I16.1
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
I16.1 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Use Additional Code
When coding I16.1, also report these additional codes when applicable.
- code, if applicable, to identify specific organ dysfunction, such as:
- acute kidney injury (N17.-)
- acute myocardial infarction (I21.-)
- acute pulmonary edema (left and/or right ventricular failure) (J81.0, I50.-)
- aortic dissection (I71.0-)
- cerebral hemorrhage (I60.-. I61.-, I62.-)
- cerebral infarction (I63.-)
- eclampsia (O15.-)
- hypertensive encephalopathy (I67.4)
- seizure (R56.9)
Inpatient DRG Impact, CC
code Hypertensive emergency. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for I16.1
Local Coverage Determinations (LCDs) from CMS MACs that list I16.1 as a covered diagnosis.
Showing top 10 of 143 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing I16.1.
5 Medicare
CPT Codes Commonly Billed with I16.1
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 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
- 94761 CMS LCD: Billing and Coding: Noninvasive Ear or Pulse Oximetry For Oxygen Saturation CMS LCD
Convert I16.1 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 |
|---|---|---|
| I16.1 | 4019 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To I16.1
Other codes in section I10-I1A (Hypertensive diseases).
ICD-10 I16.1, Billing FAQ
Is ICD-10 code I16.1 billable? +
Yes, I16.1 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Is I16.1 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with I16.1? +
Procedures frequently paired with I16.1 include: 83880, 94762, 94760, 94761.
What ICD-9 codes does I16.1 map to? +
Per CMS GEMs, I16.1 maps to ICD-9 codes: 4019. 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 June 1, 2026.
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