ICD-10 I50.1
Billable / Specific HCC v28: 85 CCLeft ventricular failure, unspecified
About ICD-10-CM I50.1
ICD-10-CM code I50.1 represents Left ventricular failure, unspecified. This is a billable/specific code in the Circulatory System chapter (block I50). The 2026 edition of ICD-10-CM I50.1 became effective on October 1, 2025.
Coding Tips for I50.1
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
I50.1 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.
I50.1 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.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under I50.1. Per CMS ICD-10-CM Tabular 2026.
- Cardiac asthma
- Edema of lung with heart disease NOS
- Edema of lung with heart failure
- Left heart failure
- Pulmonary edema with heart disease NOS
- Pulmonary edema with heart failure
Type 1 Excludes
Pure excludes, these codes can never be coded together with I50.1. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- edema of lung without heart disease or heart failure (J81.-)
- pulmonary edema without heart disease or failure (J81.-)
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 Left ventricular failure, unspecified. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for I50.1
Local Coverage Determinations (LCDs) from CMS MACs that list I50.1 as a covered diagnosis.
Showing top 10 of 657 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing I50.1.
3 Aetna
2 Cigna
5 Medicare
CPT Codes Commonly Billed with I50.1
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 0077U CMS LCD: Billing and Coding: Mass Spectrometry (MS) Testing in Monoclonal Gammopathy (MG) CMS LCD
- 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
- 90999 CMS LCD: Billing and Coding: Frequency of Hemodialysis CMS LCD
Convert I50.1 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 |
|---|---|---|
| I50.1 | 4281 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To I50.1
Other codes in section I30-I5A (Other forms of heart disease).
ICD-10 I50.1, Billing FAQ
Is ICD-10 code I50.1 billable? +
Yes, I50.1 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 I50.1? +
ICD-10 I50.1 includes: Cardiac asthma; Edema of lung with heart disease NOS; Edema of lung with heart failure, and 3 more clinical synonyms.
What codes are Type 1 Excludes for I50.1? +
Type 1 Excludes (never code together with I50.1): edema of lung without heart disease or heart failure (J81.-); pulmonary edema without heart disease or failure (J81.-)
Does I50.1 affect Medicare Advantage HCC risk adjustment? +
Yes. I50.1 maps to CMS-HCC v28 category 85. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is I50.1 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 I50.1? +
Procedures frequently paired with I50.1 include: 0077U, 83880, 94762, 94760, 94761.
What ICD-9 codes does I50.1 map to? +
Per CMS GEMs, I50.1 maps to ICD-9 codes: 4281. 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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