ICD-10 I28.0
Billable / Specific HCC v28: 85 CCArteriovenous fistula of pulmonary vessels
About ICD-10-CM I28.0
ICD-10-CM code I28.0 represents Arteriovenous fistula of pulmonary vessels. This is a billable/specific code in the Circulatory System chapter (block I28). The 2026 edition of ICD-10-CM I28.0 became effective on October 1, 2025.
Coding Tips for I28.0
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
I28.0 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.
I28.0 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.
Type 1 Excludes
Pure excludes, these codes can never be coded together with I28.0. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- congenital arteriovenous fistula (Q25.72)
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 Arteriovenous fistula of pulmonary vessels. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for I28.0
Local Coverage Determinations (LCDs) from CMS MACs that list I28.0 as a covered diagnosis.
Showing top 10 of 331 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing I28.0.
2 Cigna
5 Medicare
2 Aetna
CPT Codes Commonly Billed with I28.0
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 I28.0 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 |
|---|---|---|
| I28.0 | 4170 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To I28.0
Other codes in section I26-I28 (Pulmonary heart disease and diseases of pulmonary circulation).
ICD-10 I28.0, Billing FAQ
Is ICD-10 code I28.0 billable? +
Yes, I28.0 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What codes are Type 1 Excludes for I28.0? +
Type 1 Excludes (never code together with I28.0): congenital arteriovenous fistula (Q25.72)
Does I28.0 affect Medicare Advantage HCC risk adjustment? +
Yes. I28.0 maps to CMS-HCC v28 category 85. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is I28.0 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 ICD-9 codes does I28.0 map to? +
Per CMS GEMs, I28.0 maps to ICD-9 codes: 4170. Useful for legacy data review and historical claim analysis.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team