ICD-10 I31.4
Billable / Specific CCCardiac tamponade
About ICD-10-CM I31.4
ICD-10-CM code I31.4 represents Cardiac tamponade. This is a billable/specific code in the Circulatory System chapter (block I31). The 2026 edition of ICD-10-CM I31.4 became effective on October 1, 2025.
Coding Tips for I31.4
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
I31.4 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.
Coding Notes
Code First
- underlying cause
Inpatient DRG Impact, CC
codes Cardiac tamponade. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for I31.4
Local Coverage Determinations (LCDs) from CMS MACs that list I31.4 as a covered diagnosis.
Showing top 10 of 274 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing I31.4.
1 Aetna
5 Medicare
CPT Codes Commonly Billed with I31.4
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 I31.4 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 |
|---|---|---|
| I31.4 | 4233 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To I31.4
Other codes in section I30-I5A (Other forms of heart disease).
ICD-10 I31.4, Billing FAQ
Is ICD-10 code I31.4 billable? +
Yes, I31.4 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Is I31.4 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 I31.4 map to? +
Per CMS GEMs, I31.4 maps to ICD-9 codes: 4233. 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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