ICD-10 I50.9
Billable / Specific HCC v28: 85Heart failure, unspecified
About ICD-10-CM I50.9
ICD-10-CM code I50.9 represents Heart failure, unspecified. This is a billable/specific code in the Circulatory System chapter (block I50). The 2026 edition of ICD-10-CM I50.9 became effective on October 1, 2025.
Coding Tips for I50.9
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
I50.9 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 I50.9. Per CMS ICD-10-CM Tabular 2026.
- Cardiac, heart or myocardial failure NOS
- Congestive heart disease
- Congestive heart failure NOS
Type 2 Excludes
Not included here, the excluded code is not part of I50.9, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- fluid overload unrelated to congestive heart failure (E87.70)
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 I50.9
Local Coverage Determinations (LCDs) from CMS MACs that list I50.9 as a covered diagnosis.
Showing top 10 of 522 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing I50.9.
3 Aetna
2 Cigna
5 Medicare
CPT Codes Commonly Billed with I50.9
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 93306 Echocardiography — heart failure, cardiomyopathy, valvular disease Cardiovascular Disease
- 99205 New patient office visit — complex/high-risk: uncontrolled diabetes, heart failure, COPD exacerbation, cancer, MS, RA, CKD, CAD, recurrent depression, epilepsy, lupus, syncope, cognitive decline Primary Care
- 99215 Established patient — high complexity: HF exacerbation, COPD exacerbation, cancer management, MS, advanced CKD, uncontrolled diabetes, recurrent syncope, respiratory failure, liver cirrhosis Primary Care
- 93000 EKG 12-lead — tachycardia, bradycardia, palpitations, HTN, CAD, AFib, arrhythmia, chest pain, syncope, cardiomyopathy, AV block, bundle branch block, SVT, VT, diabetes screening, abnormal EKG Cardiology
- 93306 Echo with Doppler — heart failure, cardiomyopathy, mitral/aortic/tricuspid valve disease, chest pain, dyspnea, CAD, pulmonary HTN, ASD, VSD, congenital valve Cardiology
- 93451 Right heart cath — CAD, native vessel disease, ischemic cardiomyopathy, unstable angina, MI, heart failure, valvular disease, chest pain Cardiology
- 93452 Left heart cath — same as right heart cath indications Cardiology
- 93458 Coronary angiography — CAD, unstable angina, MI, heart failure, chest pain, prior bypass graft evaluation Cardiology
- 93350 Stress echo — known/suspected CAD, chest pain, angina, abnormal EKG, cardiomyopathy, HF, dyspnea Cardiology
- 71046 Chest X-ray 2 views — cough, dyspnea, wheezing, chest pain, pneumonia, COPD exacerbation, asthma exacerbation, respiratory failure, lung nodule, pneumothorax, heart failure, hx pneumonia, TB, hypoxemia Radiology
Convert I50.9 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 |
|---|---|---|
| I50.9 | 4280 | 10000 |
| I50.9 | 4289 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To I50.9
Other codes in section I30-I5A (Other forms of heart disease).
ICD-10 I50.9, Billing FAQ
Is ICD-10 code I50.9 billable? +
Yes, I50.9 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 I50.9? +
ICD-10 I50.9 includes: Cardiac, heart or myocardial failure NOS; Congestive heart disease; Congestive heart failure NOS.
What codes are Type 2 Excludes for I50.9? +
Type 2 Excludes (may be coded together when both conditions exist): fluid overload unrelated to congestive heart failure (E87.70)
Does I50.9 affect Medicare Advantage HCC risk adjustment? +
Yes. I50.9 maps to CMS-HCC v28 category 85. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with I50.9? +
Procedures frequently paired with I50.9 include: 93306, 99205, 99215, 93000, 93306.
What ICD-9 codes does I50.9 map to? +
Per CMS GEMs, I50.9 maps to ICD-9 codes: 4280, 4289. 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 July 16, 2026.
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