ICD-10 I27.0
Billable / Specific HCC v28: 85 CCPrimary pulmonary hypertension
About ICD-10-CM I27.0
ICD-10-CM code I27.0 represents Primary pulmonary hypertension. This is a billable/specific code in the Circulatory System chapter (block I27). The 2026 edition of ICD-10-CM I27.0 became effective on October 1, 2025.
Coding Tips for I27.0
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
I27.0 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.
I27.0 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.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under I27.0. Per CMS ICD-10-CM Tabular 2026.
- Heritable pulmonary arterial hypertension
- Idiopathic pulmonary arterial hypertension
- Primary group 1 pulmonary hypertension
- Primary pulmonary arterial hypertension
Type 1 Excludes
Pure excludes, these codes can never be coded together with I27.0. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- persistent pulmonary hypertension of newborn (P29.30)
- pulmonary hypertension NOS (I27.20)
- secondary pulmonary arterial hypertension (I27.21)
- secondary pulmonary hypertension (I27.29)
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.
Inpatient DRG Impact, CC
codes Primary pulmonary hypertension. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for I27.0
Local Coverage Determinations (LCDs) from CMS MACs that list I27.0 as a covered diagnosis.
Showing top 10 of 503 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing I27.0.
3 Aetna
2 Cigna
5 Medicare
CPT Codes Commonly Billed with I27.0
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
Convert I27.0 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 |
|---|---|---|
| I27.0 | 4160 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To I27.0
Other codes in section I26-I28 (Pulmonary heart disease and diseases of pulmonary circulation).
ICD-10 I27.0, Billing FAQ
Is ICD-10 code I27.0 billable? +
Yes, I27.0 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 I27.0? +
ICD-10 I27.0 includes: Heritable pulmonary arterial hypertension; Idiopathic pulmonary arterial hypertension; Primary group 1 pulmonary hypertension, and 1 more clinical synonyms.
What codes are Type 1 Excludes for I27.0? +
Type 1 Excludes (never code together with I27.0): persistent pulmonary hypertension of newborn (P29.30); pulmonary hypertension NOS (I27.20); secondary pulmonary arterial hypertension (I27.21)
Does I27.0 affect Medicare Advantage HCC risk adjustment? +
Yes. I27.0 maps to CMS-HCC v28 category 85. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is I27.0 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 I27.0? +
Procedures frequently paired with I27.0 include: 94618, 94619, 94617.
What ICD-9 codes does I27.0 map to? +
Per CMS GEMs, I27.0 maps to ICD-9 codes: 4160. 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 May 31, 2026.
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