ICD-10 I27.81
Billable / Specific HCC v28: 85Cor pulmonale (chronic)
About ICD-10-CM I27.81
ICD-10-CM code I27.81 represents Cor pulmonale (chronic). This is a billable/specific code in the Circulatory System chapter (block I27). The 2026 edition of ICD-10-CM I27.81 became effective on October 1, 2025.
Coding Tips for I27.81
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
I27.81 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 I27.81. Per CMS ICD-10-CM Tabular 2026.
- Cor pulmonale NOS
Type 1 Excludes
Pure excludes, these codes can never be coded together with I27.81. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- acute cor pulmonale (I26.0-)
Coding Notes
Code Also
- , if applicable, right heart failure (I50.81-)
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 I27.81
Local Coverage Determinations (LCDs) from CMS MACs that list I27.81 as a covered diagnosis.
Showing top 10 of 390 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing I27.81.
2 Cigna
5 Medicare
CPT Codes Commonly Billed with I27.81
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert I27.81 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 |
|---|---|---|
| I27.81 | 4169 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To I27.81
Other codes in section I26-I28 (Pulmonary heart disease and diseases of pulmonary circulation).
ICD-10 I27.81, Billing FAQ
Is ICD-10 code I27.81 billable? +
Yes, I27.81 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 I27.81? +
ICD-10 I27.81 includes: Cor pulmonale NOS.
What codes are Type 1 Excludes for I27.81? +
Type 1 Excludes (never code together with I27.81): acute cor pulmonale (I26.0-)
Does I27.81 affect Medicare Advantage HCC risk adjustment? +
Yes. I27.81 maps to CMS-HCC v28 category 85. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What ICD-9 codes does I27.81 map to? +
Per CMS GEMs, I27.81 maps to ICD-9 codes: 4169. 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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