2026 ICD-10-CM Diagnosis Code I28.0Arteriovenous fistula of pulmonary vessels
ICD-10-CM Codes›I00–I99›I26-I28›I28
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- Risk Adjusts — HCC 226
- Chronic Condition
I28.0 is a billable ICD-10-CM diagnosis code for arteriovenous fistula of pulmonary vessels. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 314 through 316. 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 4 closely related codes. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Pulmonary heart disease.
For Medicare Advantage risk adjustment, I28.0 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.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
I28.0 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.
- Arteriovenous fistula of pulmonary vessels
- Arteriovenous fistula of pulmonary vessels following superior cavopulmonary anastomosis
- Postoperative fistula
- Pulmonary arteriovenous aneurysm
- Pulmonary arteriovenous malformation
- TEMPI syndrome
Tabular List NotesGuidance
Coding notes and annotation back-references applicable to this code.
Type 1 Excludes
- congenital arteriovenous fistula Q25.72
A type 1 excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Aneurysm (anastomotic) (artery) (cirsoid) (diffuse) (false) (fusiform) (multiple) (saccular) I72.9
arteriovenous (congenital) See Also: Malformation, arteriovenous;
acquired I28.0
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
TEMPI Syndrome
a rare syndrome characterized by telangiectasias, elevated erythropoietin level and erythrocytosis, monoclonal gammopathy, perinephric fluid collections, and intrapulmonary shunting. it is best classified as a type of plasma cell dyscrasia with paraneoplastic manifestations.
Patient EducationClinical
Fistulas
A fistula is an abnormal connection between two parts inside of the body. Fistulas may develop between different organs, such as between the esophagus and the windpipe or the bowel and the vagina. They can also develop between two blood vessels, such as between an artery and a vein or between two arteries.
Read the full article at MedlinePlus
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Convert I28.0 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About I28.0Overview
What is the ICD-10 code for arteriovenous fistula of pulmonary vessels?
The ICD-10-CM code for arteriovenous fistula of pulmonary vessels is I28.0 (sometimes written as I280). It is billable on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
Is I28.0 (Other diseases of pulmonary vessels) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report arteriovenous fistula of pulmonary vessels on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What MS-DRG does I28.0 group to?
When arteriovenous fistula of pulmonary vessels is the principal diagnosis on an inpatient stay, it groups to MS-DRG 314, 315, 316, with relative weights from 0.6821 to 2.0852 depending on complications. Higher weights mean higher Medicare reimbursement.
Is I28.0 a CC or MCC?
CMS lists I28.0 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 4 closely related codes in its exclusion list.
What is the ICD-9 equivalent of I28.0?
Under the General Equivalence Mappings, arteriovenous fistula of pulmonary vessels converts to ICD-9-CM 417.0 (arterioven fistu pul ves). The mapping is a direct match.
What HCC is I28.0?
I28.0 (arteriovenous fistula of pulmonary vessels) 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 184.
Does I28.0 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, I28.0 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.
