ICD-10 I97.130
Billable / Specific CCPostprocedural heart failure following cardiac surgery
About ICD-10-CM I97.130
ICD-10-CM code I97.130 represents Postprocedural heart failure following cardiac surgery. This is a billable/specific code in the Circulatory System chapter (block I97). The 2026 edition of ICD-10-CM I97.130 became effective on October 1, 2025.
Coding Tips for I97.130
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
I97.130 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.
Inpatient DRG Impact, CC
codes Postprocedural heart failure following cardiac surgery. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for I97.130
Local Coverage Determinations (LCDs) from CMS MACs that list I97.130 as a covered diagnosis.
Showing top 10 of 326 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing I97.130.
5 Medicare
2 Aetna
CPT Codes Commonly Billed with I97.130
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 33993 CMS LCD: Billing and Coding: Percutaneous Ventricular Assist Device CMS LCD
- 33990 CMS LCD: Billing and Coding: Percutaneous Ventricular Assist Device CMS LCD
- 33991 CMS LCD: Billing and Coding: Percutaneous Ventricular Assist Device CMS LCD
- 33992 CMS LCD: Billing and Coding: Percutaneous Ventricular Assist Device CMS LCD
- 33995 CMS LCD: Billing and Coding: Percutaneous Ventricular Assist Device CMS LCD
- 33997 CMS LCD: Billing and Coding: Percutaneous Ventricular Assist Device CMS LCD
Convert I97.130 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 |
|---|---|---|
| I97.130 | 4294 | 10000 |
| I97.130 | 4294 | 10112 |
| I97.130 | 9971 | 10111 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To I97.130
Other codes in section I95-I99 (Other and unspecified disorders of the circulatory system).
ICD-10 I97.130, Billing FAQ
Is ICD-10 code I97.130 billable? +
Yes, I97.130 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Is I97.130 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 I97.130? +
Procedures frequently paired with I97.130 include: 33993, 33990, 33991, 33992, 33995.
What ICD-9 codes does I97.130 map to? +
Per CMS GEMs, I97.130 maps to ICD-9 codes: 4294, 4294, 9971. 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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