ICD-10 R57.0
Billable / Specific HCC v28: 84 MCCCardiogenic shock
About ICD-10-CM R57.0
ICD-10-CM code R57.0 represents Cardiogenic shock. This is a billable/specific code in the Symptoms, Signs, and Abnormal Findings chapter (block R57). The 2026 edition of ICD-10-CM R57.0 became effective on October 1, 2025.
Coding Tips for R57.0
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
R57.0 is a CMS-HCC v28 risk-adjustment code (category 84). 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.
R57.0 is designated MCC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-MCC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag MCC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Type 2 Excludes
Not included here, the excluded code is not part of R57.0, but a patient may have both conditions at the same time. Both codes may be coded together when applicable.
- septic shock (R65.21)
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, MCC
codes Cardiogenic shock. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for R57.0
Local Coverage Determinations (LCDs) from CMS MACs that list R57.0 as a covered diagnosis.
Showing top 10 of 325 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing R57.0.
4 Cigna
5 Medicare
CPT Codes Commonly Billed with R57.0
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 99291 Critical care — cardiac arrest, respiratory failure, shock, anaphylaxis Emergency Medicine
- 99285 ED visit level 5 — STEMI, massive PE, respiratory failure, cardiogenic shock, cardiac arrest, ICH, encephalopathy, coma, anaphylaxis, SAH, ARDS, compartment syndrome Emergency Medicine
- 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 R57.0 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 |
|---|---|---|
| R57.0 | 78551 | 00000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To R57.0
Other codes in section R50-R69 (General symptoms and signs).
ICD-10 R57.0, Billing FAQ
Is ICD-10 code R57.0 billable? +
Yes, R57.0 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What codes are Type 2 Excludes for R57.0? +
Type 2 Excludes (may be coded together when both conditions exist): septic shock (R65.21)
Does R57.0 affect Medicare Advantage HCC risk adjustment? +
Yes. R57.0 maps to CMS-HCC v28 category 84. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is R57.0 a CC or MCC for inpatient DRG? +
Yes, this code is designated as MCC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with R57.0? +
Procedures frequently paired with R57.0 include: 99291, 99285, 33993, 33990, 33991.
What ICD-9 codes does R57.0 map to? +
Per CMS GEMs, R57.0 maps to ICD-9 codes: 78551. 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 18, 2026.
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