2026 ICD-10-CM Diagnosis Code I13.11Hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease
ICD-10-CM Codes›I00–I99›I10-I1A›I13
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 326
- Chronic Condition
I13.11 is a billable ICD-10-CM diagnosis code for hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 8, 19, 673 through 675, 682 through 684. 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 benign hypertensive heart disease. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Chronic kidney disease and Hypertension with complications and secondary hypertension.
For Medicare Advantage risk adjustment, I13.11 maps to CMS-HCC Category 326 (Chronic Kidney Disease, Stage 5) under the V28 model, adding a risk factor of about 0.815 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
I13.11 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.
- Benign hypertensive heart disease
- Benign hypertensive heart disease and chronic renal disease stage 5
- Chronic kidney disease stage 5 due to hypertension
- Hypertensive heart AND chronic kidney disease stage 5
- Hypertensive heart and renal disease with renal failure
- Hypertensive renal failure
Tabular List NotesGuidance
Coding notes and annotation back-references applicable to this code.
Use Additional Code
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 I13.11 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About I13.11Overview
Is I13.11 a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What MS-DRG does I13.11 group to?
When hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease is the principal diagnosis on an inpatient stay, it groups to MS-DRG 8, 19, 673, 674, 675, 682, 683, 684, with relative weights from 0.6003 to 6.6272 depending on complications. Higher weights mean higher Medicare reimbursement.
Is I13.11 a CC or MCC?
CMS lists I13.11 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 I13.11?
Under the General Equivalence Mappings, hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease converts to ICD-9-CM 404.02 (mal hy ht/kd st V w/o hf), 404.12 (ben hy ht/kd st V w/o hf), and 404.92 (hy ht/kd NOS st V w/o hf). The mapping is approximate, so confirm the match fits the documentation.
What HCC is I13.11?
I13.11 (hypertensive heart and chronic kidney disease without heart failure, with stage 5 chronic kidney disease, or end stage renal disease) maps to CMS-HCC Category 326 (Chronic Kidney Disease, Stage 5), commonly written as HCC 326, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2026. It mapped to HCC 136 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 262.
Does I13.11 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, I13.11 adds a risk adjustment factor of about 0.815 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.815 to 1.050 depending on the payment segment). HCC 326 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 326 category page.
