ICD-10 I50.814
Billable / Specific HCC v28: 85Right heart failure due to left heart failure
About ICD-10-CM I50.814
ICD-10-CM code I50.814 represents Right heart failure due to left heart failure. This is a billable/specific code in the Circulatory System chapter (block I50). The 2026 edition of ICD-10-CM I50.814 became effective on October 1, 2025.
Coding Tips for I50.814
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
I50.814 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 I50.814. Per CMS ICD-10-CM Tabular 2026.
- Right ventricular failure secondary to left ventricular failure
Type 1 Excludes
Pure excludes, these codes can never be coded together with I50.814. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- Right heart failure with but not due to left heart failure (I50.82)
Coding Notes
Code Also
- the type of left ventricular failure, if known (I50.2-I50.43)
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 I50.814
Local Coverage Determinations (LCDs) from CMS MACs that list I50.814 as a covered diagnosis.
Showing top 10 of 400 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing I50.814.
5 Medicare
CPT Codes Commonly Billed with I50.814
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 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
Codes Adjacent To I50.814
Other codes in section I30-I5A (Other forms of heart disease).
ICD-10 I50.814, Billing FAQ
Is ICD-10 code I50.814 billable? +
Yes, I50.814 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 I50.814? +
ICD-10 I50.814 includes: Right ventricular failure secondary to left ventricular failure.
What codes are Type 1 Excludes for I50.814? +
Type 1 Excludes (never code together with I50.814): Right heart failure with but not due to left heart failure (I50.82)
Does I50.814 affect Medicare Advantage HCC risk adjustment? +
Yes. I50.814 maps to CMS-HCC v28 category 85. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with I50.814? +
Procedures frequently paired with I50.814 include: 94762, 94760, 94761, 90999.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on September 1, 2026.
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