Is ICD-10-CM code I11 billable?

No, I11 (Hypertensive heart disease) is a non-billable ICD-10-CM code. It must be coded to a more specific subcategory before it can be used for reimbursement.

What chapter does ICD-10-CM code I11 belong to?

I11 belongs to Chapter 9 of the ICD-10-CM tabular list: I00–I99 (Diseases of the Circulatory System).

I11Not billable, use a more specific code below

Hypertensive heart disease

In Hypertensive diseases (I10-I1A), chapter 9: Diseases of the Circulatory System

2 billable codes under I11: none are a CC or MCC; 1 map to HCC 226 (Heart Failure, Except End-Stage and Acute).An HCC counts toward a Medicare Advantage patient's risk score.

Instructional notes

Includes: conditions that are coded here

any condition in I50.- or I51.4-I51.7, I51.89, I51.9 due to hypertension

Also applies, from Hypertensive diseases (I10-I1A)

These notes sit on I10-I1A and apply to every code under it, including I11.

Excludes1: not coded here, use a different code

neonatal hypertension (P29.2)
primary pulmonary hypertension (I27.0)

Excludes2: not included here, code separately if applicable

hypertensive disease complicating pregnancy, childbirth and the puerperium (O10-O11, O13-O16)

Use additional code: add a second code for this, listed after this one

code to identify:
exposure to environmental tobacco smoke (Z77.22)
history of tobacco dependence (Z87.891)
occupational exposure to environmental tobacco smoke (Z57.31)
tobacco dependence (F17.-)
tobacco use (Z72.0)

Official coding guidelines

From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.

Section I.C.9.a Hypertension (page 50), covers I11
Presume hypertension is linked to heart disease and CKD unless documented as unrelated: use I11, I12, or I13 with additional I50 or N18 codes as directed. Other conditions need provider-documented linkage to be coded as related.

All codes under I11

I11 can't be used on a claim. Pick a billable code below; grey headings group them.

I11 MS-DRGs

As the principal diagnosis, the billable codes under I11 group to these 13 MS-DRGs (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

DRG 291 Heart Failure and Shock with MCC (1 of 2 codes)
DRG 292 Heart Failure and Shock with CC (1 of 2 codes)
DRG 293 Heart Failure and Shock without CC/MCC (1 of 2 codes)
DRG 304 Hypertension with MCC (1 of 2 codes)
DRG 305 Hypertension without MCC (1 of 2 codes)
DRG 673 Other Kidney and Urinary Tract Procedures with MCC (1 of 2 codes)
DRG 674 Other Kidney and Urinary Tract Procedures with CC (1 of 2 codes)
DRG 675 Other Kidney and Urinary Tract Procedures without CC/MCC (1 of 2 codes)
DRG 682 Renal Failure with MCC (1 of 2 codes)
DRG 683 Renal Failure with CC (1 of 2 codes)
DRG 684 Renal Failure without CC/MCC (1 of 2 codes)
DRG 791 Prematurity with Major Problems (1 of 2 codes)
DRG 793 Full Term Neonate with Major Problems (1 of 2 codes)

Other codes that refer to I11

Notes on these codes point to I11.

I13 Includes: any condition in I11.- with any condition in I12.-
I51.5 Excludes1: myocardial degeneration due to hypertension (I11.-)
I51.7 Excludes1: cardiomegaly due to hypertension (I11.-)
I67.4 Code Also: hypertensive heart disease (I11.-)
I87.2 Code Also: hypertensive heart disease (I11.-)
O10.1 Use Additional Code: code from I11 to identify the type of hypertensive heart disease
O10.1 Includes: Any condition in I11 specified as a reason for obstetric care during pregnancy, childbirth or the puerperium

About the condition

Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.

Heart Diseases

Heart disease is a general term that includes many types of heart problems. It's a type of cardiovascular disease, which means heart and blood vessel disease.

High Blood Pressure

Blood pressure is the force of your blood pushing against the walls of your arteries. Each time your heart beats, it pumps blood into the arteries. Your blood pressure is highest when your heart beats, pumping the blood. This is called systolic pressure. When your heart is at rest, between beats, your blood pressure falls. This is called diastolic pressure.

Code history

Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.