I50.22: Chronic systolic (congestive) heart failure

The ICD-10-CM code for heart failure documented as systolic dysfunction at a chronic baseline, with no acute decompensation recorded at the encounter.

Billable

FY2027

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At a glance

Code Family

I50: Heart failure

Condition

Systolic heart failure

HCC Mapping (v28)

HCC 226: Heart Failure, Except End-Stage and Acute.

DRG Grouping

MS-DRG 291, 292 or 293 under the FY2027 MS-DRG v44 grouper, depending on complications and comorbidities.

Family Specificity

Subcategory I50.2 carries four billable child codes, three of them split by acuity, with I50.22 as the chronic, non-decompensated selection and I50.20 the unspecified one.

Billable

Yes, valid for HIPAA covered transactions in the FY2027 code set.

Which I50 code do I assign?

The I50 family splits on two axes: the type of dysfunction (systolic, diastolic or combined) and the acuity documented at the encounter (acute, chronic or acute on chronic). I50.22 sits at the intersection of systolic type and chronic acuity.

When documentation says…

Code

Chronic systolic heart failure, LVEF 35 percent, stable

I50.22

Chronic systolic heart failure with no acute decompensation at this encounter. The provider must document the type as systolic or as heart failure with reduced ejection fraction (HFrEF), an inclusion term at I50.2. ICD-10-CM sets no ejection fraction threshold for the type. The note must also establish chronicity, through the word chronic, the phrase at baseline, or the absence of any language indicating acute decompensation.

Acute decompensated heart failure on a chronic systolic baseline

I50.23

Acute on chronic systolic heart failure. The note documents an acute exacerbation layered on the patient's chronic systolic baseline. This selection maps to HCC 224 rather than HCC 226.

New onset acute systolic heart failure, no prior history

I50.21

Acute systolic heart failure without an established chronic baseline. This selection maps to HCC 225.

Chronic heart failure with preserved ejection fraction

I50.32

Chronic diastolic heart failure. The provider documents the type as diastolic or as heart failure with preserved ejection fraction (HFpEF), an inclusion term at I50.3.

CHF, type not stated

I50.9

Heart failure, unspecified. A note reading only CHF, with no systolic or diastolic specification, defaults here. The coder may query the provider when an ejection fraction is recorded but the note does not state systolic.

Hypertensive heart disease with chronic systolic heart failure

I11.0

Hypertensive heart disease with heart failure. Guideline I.C.9.a.1 assigns hypertension with heart failure to category I11. The Code first note at category I50 sequences I11.0 ahead of I50.22, which follows as a secondary code. When chronic kidney disease is also documented, Guideline Section I.C.9.a.3 directs a code from category I13 instead of I11.0. Assign I13.0 for stage 1 through stage 4 or unspecified chronic kidney disease. Assign I13.2 for stage 5 chronic kidney disease or end stage renal disease.

Tabular notes

CODE ALSO

Code also end stage heart failure, if applicable (I50.84). This note sits at subcategory I50.2 and applies to I50.22. When the provider documents end stage heart failure, report I50.84 with I50.22.

CODE FIRST

Category I50 carries a Code first note that applies to I50.22. Code first heart failure complicating abortion or ectopic or molar pregnancy (O00-O07, O08.8), heart failure due to hypertension (I11.0), heart failure due to hypertension with chronic kidney disease (I13.-), heart failure following surgery (I97.13-), obstetric surgery and procedures (O75.4) and rheumatic heart failure (I09.81).

FY2027: EFFECTIVE 1 OCTOBER 2026

The FY2027 codes addenda make no addition, deletion or revision in category I50. The FY2027 tabular addenda make no change to the I50 or I50.2 notes. In the FY2027 text of Section I.C.9.a.1, hypertension with a heart condition classified to I50.-, Heart failure, I51.4, Myocarditis, unspecified, I51.89, Other ill-defined heart diseases, or I51.9, Heart disease, unspecified, is assigned to a code from category I11. An additional code identifies the heart condition. Hypertension with I51.5, Myocardial degeneration, or I51.7, Cardiomegaly, is also assigned to category I11, with no additional code for the heart condition. I50.22 is unchanged in the FY2027 update.

Operational & financial impact

Why specificity matters beyond the chart: risk adjustment, DRG assignment and denial exposure all follow from which code is selected.

CMS-HCC v28 (PY2024+)

HCC 226: Heart Failure, Except End-Stage and Acute.

The heart failure axis carries three acuity based categories: HCC 224 for acute on chronic heart failure, HCC 225 for acute heart failure, and HCC 226 for chronic or unspecified heart failure.

For Medicare Advantage risk recapture, the chronic heart failure diagnosis must appear on an active clinical encounter note dated within the relevant measurement year. A problem list entry alone does not support recapture. Annual echocardiography and medication management notes support recapture.

MS-DRG v44 (FY2027)

MS-DRG 291: Heart failure and shock with MCC.

MS-DRG 292: Heart failure and shock with CC.

MS-DRG 293: Heart failure and shock without CC/MCC.

Inpatient admissions with I50.22 as the principal diagnosis group to MS-DRG 291, 292 or 293 under the FY2027 MS-DRG v44 grouper. As a secondary diagnosis, I50.22 is a complication or comorbidity (CC) under MS-DRG v44, per CMS Table 6J. The tier follows the presence and severity of complications and comorbidities.

WHERE SPECIFICITY IS LOST

A note reading only CHF, with no systolic or diastolic type stated, defaults to I50.9, Heart failure, unspecified.

Acuity moves the code between HCC categories. An acute on chronic presentation maps to HCC 224. An acute presentation maps to HCC 225. Chronic systolic heart failure maps to HCC 226.

Documenting the type and the acuity is what separates I50.22 from I50.9, I50.21 and I50.23.

Medicare and commercial payers

I50.22 is a valid diagnosis code for Medicare Part A and Part B claims.

The CMS-HCC v28 rules described here apply to Medicare Advantage risk adjustment.

Documentation checklist to support I50.22

Chart elements that support code selection and reduce specificity-driven denials.

An explicit diagnosis statement of heart failure.

The heart failure type documented by the provider as systolic or as heart failure with reduced ejection fraction (HFrEF). An ejection fraction value alone does not establish the type.

Chronicity, stated as chronic or at baseline, or an absence of any language indicating acute decompensation.

The cause of the heart failure when it is known, such as hypertensive heart disease, ischemic cardiomyopathy or dilated cardiomyopathy.

Documented hypertension when present, which directs a code from category I11 to a position ahead of I50.22. When chronic kidney disease is also documented, the code comes from category I13 instead.

End stage heart failure when the provider documents it, to support I50.84 under the Code also note at I50.2.

Evidence of active clinical management within the measurement year, such as an annual echocardiogram or a medication management note, to support HCC 226 recapture.

For outpatient encounters, a confirmed diagnosis only. A rule out or possible systolic heart failure is not coded in the outpatient setting. Code the presenting sign or symptom instead.

FAQ

When is I50.22 correct instead of I50.23?

Use I50.22 for stable chronic systolic heart failure with no acute decompensation documented at the encounter. Use I50.23 when the provider documents an acute exacerbation layered on the patient's chronic systolic baseline.

Is I50.22 billable?

Yes. I50.22 is a valid billable code for HIPAA covered transactions, in the FY2027 code set, effective 1 October 2026.

Does I50.22 require documentation of ejection fraction?

The I50.2 codes require documentation of systolic dysfunction. That means the word systolic, or evidence of a reduced ejection fraction at or below 40 percent. Without either, I50.9, Heart failure, unspecified, is the correct code.

What HCC does I50.22 map to under v28?

I50.22 maps to HCC 226, Heart Failure, Except End-Stage and Acute.

How do I sequence I50.22 when hypertension is also documented?

Assign I11.0, Hypertensive heart disease with heart failure, ahead of I50.22. The Code first note at category I50 sets that order. Guideline I.C.9.a presumes the causal link unless the provider documents that the heart failure is unrelated to the hypertension. When chronic kidney disease is also documented, Guideline Section I.C.9.a.3 directs a code from category I13 instead of I11. Assign I13.0 for stage 1 through stage 4 or unspecified chronic kidney disease. Assign I13.2 for stage 5 chronic kidney disease or end stage renal disease.

What changed for I50.22 in FY2027?

I50.22 is unchanged in the FY2027 update, which makes no addition, deletion or revision in category I50 and no change to the I50 notes. In the FY2027 text of Section I.C.9.a.1, I51.4, Myocarditis, unspecified, I51.89, Other ill-defined heart diseases, and I51.9, Heart disease, unspecified, are listed alongside I50 in that instruction. I51.5, Myocardial degeneration, and I51.7, Cardiomegaly, are also assigned to category I11 but take no additional code.

Does inpatient coding differ from outpatient coding for I50.22?

Yes. In the outpatient setting, code only confirmed diagnoses. In the inpatient setting, a diagnosis documented as probable or likely at discharge may be coded as confirmed under UHDDS guidelines. Query the provider when the documentation is ambiguous between systolic and diastolic.

What coding errors affect I50.22?

Assigning I50.22 when the note documents acute decompensated heart failure, which calls for I50.23. Using I50.9 when the provider documents systolic heart failure or HFrEF. Sequencing I50.22 ahead of I11.0 when hypertension is documented. Omitting I50.84 under the Code also note at I50.2 when end stage heart failure is documented. Assigning I11.0 instead of a code from category I13 when chronic kidney disease is also documented.

Related codes

Codes in the same family as I50.22. Only codes with a published page render as links.

Sibling codes in the I50 family

I50.20: Unspecified systolic (congestive) heart failure.
I50.21: Acute systolic (congestive) heart failure.
I50.23: Acute on chronic systolic (congestive) heart failure.
I50.31: Acute diastolic (congestive) heart failure.
I50.32: Chronic diastolic (congestive) heart failure.
I50.33: Acute on chronic diastolic (congestive) heart failure.
I50.41: Acute combined systolic (congestive) and diastolic (congestive) heart failure.
I50.42: Chronic combined systolic (congestive) and diastolic (congestive) heart failure.
I50.43: Acute on chronic combined systolic (congestive) and diastolic (congestive) heart failure.
I50.9: Heart failure, unspecified.

Additional codes to consider

Codes outside the I50 family considered alongside I50.22.

Companion: code alongside when documented

I11.0: Hypertensive heart disease with heart failure, sequenced first under the I50 Code first note when hypertension is documented, unless the provider states the heart failure is unrelated.
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. It replaces I11.0 when chronic kidney disease at these stages is also documented.
I13.2: Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease. It replaces I11.0 when either is also documented.
I50.84: End stage heart failure, reported alongside I50.22 under the Code also note at I50.2.

Consider instead

I50.23: Acute on chronic systolic (congestive) heart failure, when an acute decompensation is documented.
I50.21: Acute systolic (congestive) heart failure, with no established chronic baseline.
I50.32: Chronic diastolic (congestive) heart failure, when the ejection fraction is preserved.
I50.9: Heart failure, unspecified, when no systolic or diastolic type is documented.

Sources

All claims on this page derive from government and professional-standards sources.

National Center for Health Statistics. (2026). International classification of diseases, tenth revision, clinical modification (ICD-10-CM) FY2027 files. https://www.cdc.gov/nchs/icd/icd-10-cm/files.html
Centers for Medicare & Medicaid Services and National Center for Health Statistics. (2026). ICD-10-CM official guidelines for coding and reporting FY2027. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2027/ICD-10-CM-October-1-2026-FY27-Guidelines.pdf
Centers for Medicare & Medicaid Services. (2025). 2026 model software/ICD-10 mappings. https://www.cms.gov/medicare/payment/medicare-advantage-rates-statistics/risk-adjustment/2026-model-software-icd-10-mappings
Centers for Medicare & Medicaid Services. (2026). MS-DRG classifications and software, version 44. https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/ms-drg-classifications-and-software