2026 ICD-10-CM Diagnosis Code I13.0Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease
ICD-10-CM Codes›I00–I99›I10-I1A›I13
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 226
- Chronic Condition
I13.0 is a billable ICD-10-CM diagnosis code for hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 291 through 293, 791, 793. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 26 closely related codes. Coders also document this condition as hypertensive heart AND chronic kidney disease with congestive heart failure. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Chronic kidney disease, Heart failure, and Hypertension with complications and secondary hypertension.
For Medicare Advantage risk adjustment, I13.0 maps to CMS-HCC Category 226 (Heart Failure, Except End Stage and Acute) under the V28 model, adding a risk factor of about 0.360 for a community, non-dual, aged beneficiary in payment year 2026.
This medical diagnosis code is frequently used in Cardiology medical specialties to designate conditions such heart failure.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
I13.0 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2026.
Source: CMS Payment Year 2026 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Hypertensive heart AND chronic kidney disease with congestive heart failure
- Hypertensive heart AND renal disease complicating AND/OR reason for care during childbirth
- Hypertensive heart AND renal disease in obstetric context
- Hypertensive heart and renal disease with heart failure
- Hypertensive heart disease complicating AND/OR reason for care during childbirth
- Hypertensive renal disease complicating AND/OR reason for care during childbirth
- Hypertensive renal disease in obstetric context
Tabular List NotesGuidance
Coding notes and annotation back-references applicable to this code.
Use Additional Code
- code to identify type of heart failure I50
- code to identify stage of chronic kidney disease N18.1 N18.4 N18.9
The “use additional code” indicates that a secondary code could be used to further specify the patient’s condition. This note is not mandatory and is only used if enough information is available to assign an additional code.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Chronic Kidney Disease
You have two kidneys, each about the size of your fist. Their main job is to filter your blood. They remove wastes and extra water, which become urine. They also keep the body's chemicals balanced, help control blood pressure, and make hormones.
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert I13.0 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About I13.0Overview
Is I13.0 (Hypertensive heart and chronic kidney disease) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What MS-DRG does I13.0 group to?
When hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease is the principal diagnosis on an inpatient stay, it groups to MS-DRG 291, 292, 293, 791, 793, with relative weights from 0.5660 to 4.1696 depending on complications. Higher weights mean higher Medicare reimbursement.
Is I13.0 a CC or MCC?
CMS lists I13.0 as a CC (complication or comorbidity) for FY 2026. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 26 closely related codes in its exclusion list.
What is the ICD-9 equivalent of I13.0?
Under the General Equivalence Mappings, hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease converts to ICD-9-CM 404.01 (mal hyp ht/kd I-IV w hf), 404.11 (ben hyp ht/kd I-IV w hf), and 404.91 (hyp ht/kd NOS I-IV w hf). The mapping is approximate, so confirm the match fits the documentation.
What HCC is I13.0?
I13.0 (hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease) maps to CMS-HCC Category 226 (Heart Failure, Except End Stage and Acute), commonly written as HCC 226, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2026. It mapped to HCC 85 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. In the Part D prescription drug model it maps to RxHCC 186.
Does I13.0 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, I13.0 adds a risk adjustment factor of about 0.360 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.217 to 0.537 depending on the payment segment). A more severe related category (HCC 221, HCC 222, HCC 223, HCC 224, and HCC 225) supersedes it when both are reported. See the full factor table on the HCC 226 category page.
