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I97.13 ICD-10-CM Code: Postprocedural heart failure

Compare with another code for I97.13Check this code on a claim

Billing Status: NO. This is a non-billable ICD-10-CM code: report a more specific billable code beneath it.

Coding at a Glance

Official instructions
3 Excludes2 · 1 use-additional instruction

What these terms mean →

Not billable · FY2027A non-billable heading in the tabular list: report a more specific code beneath it.

What you need to know

Source: CMS/NCHS Official ICD-10-CM tabular notes, quoted. From the CMS/NCHS tabular list for the release in force. A note the category or block publishes applies to this code too, and is marked with where it comes from.

Use additional codeReport with this code when documented
  • Use additional code to identify the heart failure (I50.-)
Excludes2Not included here; may be reported together
  • acute pulmonary insufficiency following thoracic surgery (J95.1) (from I97.1)
  • intraoperative cardiac functional disturbances (I97.7-) (from I97.1)
  • postprocedural shock (T81.1-) (from I97)

Where it sits Source: CMS/NCHS

Under:Chapter 9: Diseases of the Circulatory SystemI95-I99 Other and unspecified disorders of the circulatory systemI97 Intraoperative and postprocedural complications and disorders of circulatory system, not elsewhere classifiedI97.1 Other postprocedural cardiac functional disturbances

Codes under I97.13 (2)

  • I97.130Postprocedural heart failure following cardiac surgeryBillable
  • I97.131Postprocedural heart failure following other surgeryBillable

Most relevant related codes MedCoder-derived

Read off the official notes above and this code’s own position in the tabular list. Which to report is a documentation question; Compare shows the two side by side.

CompareCheck ClaimView Related Codes

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for I97.13 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on I97.13 itself; “inherited from” names the category or block whose note applies here.

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code to identify the heart failure (I50.-)

Coder workflow for I97.13

MedCoder structured workflow — derived from this code’s own official record

Before you code I97.13

  1. I97.13 is not reportable as written. Select the more specific code beneath it that the documentation supports. Codes are reported to the highest level of specificity the classification provides (Guidelines I.B.2).

    ReviewI97.130, I97.131

    See the relationships section · Guide: How to choose an ICD-10-CM code →

Choose the right path

  1. Does the documentation support one of the more specific codes beneath I97.13?
    Yes → Select that code and continue the checks below on its own page.
    No → I97.13 cannot be reported as written. Where the codes beneath it include an unspecified code, that code applies when the record goes no further; otherwise query for the missing detail.

    ReviewI97.130, I97.131

Report the code beneath I97.13 that the documentation supports, not I97.13 itself. Then work the Use Additional Code note, and confirm that code is valid for the date of service on its own page.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
The conditions the Use Additional Code note names
Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.

Official instructions as workflow

  • Excludes2 — not part of I97.13(3 notes)

    Coding workflow: The conditions named in this note are not included in I97.13. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareJ95.1, I97.7, T81.1

    See the official tabular notes · Guidelines I.A.12.b

  • Use Additional Code — after identifying I97.13(1 note)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with I97.13 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    ReviewI50

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: A condition the Use Additional Code note names is documented.

Coding question: Is a second code reported with the code beneath I97.13?

Path: Review the Use Additional Code note and the code it names.

Reason: The additional code is reported when the record documents the condition; a conditional instruction applies only when its condition is met (Guidelines I.A.13).

ReviewI50

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Don’t confuse I97.13 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of I97.13 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • J95.1— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of acute pulmonary insufficiency following thoracic surgery adds J95.1; it is not part of this code and both may be reported when both are documented.

    Full comparison: I97.13 vs J95.1 →

  • I97.7— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of intraoperative cardiac functional disturbances adds I97.7; it is not part of this code and both may be reported when both are documented.

    Full comparison: I97.13 vs I97.7 →

  • T81.1— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of postprocedural shock adds T81.1; it is not part of this code and both may be reported when both are documented.

    Full comparison: I97.13 vs T81.1 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Coding context

Guidelines, coding notes, decision aids, relationships (with MS-DRG and CCSR classification), hierarchy, HCC, coverage and the context map: what a coder reaches for after the core. Each section names whether it is official source data, a MedCoder-derived relationship or MedCoder editorial.

Code Overview

Postprocedural heart failure is a non-billable ICD-10-CM category code (I97.13). A more specific billable subcode must be selected for claims submission.

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Verify Before Coding

  • Not billable as written — a more specific code is required: I97.130, I97.131.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder-derived relationships — computed from published CMS and AHRQ datasets

Other codes that name I97.13 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 14 Excludes2 notes across 3 chapters: I97.7 — Intraoperative cardiac functional disturbances (via I97.1.-), J95.1 — Acute pulmonary insufficiency following thoracic surgery (via I97.1.-), J95.2 — Acute pulmonary insufficiency following nonthoracic surgery (via I97.1.-), J95.3 — Chronic pulmonary insufficiency following surgery (via I97.1.-), T80 — Complications following infusion, transfusion and therapeutic injection (via I97.-), T80-T88 — Complications of surgical and medical care, not elsewhere classified (T80-T88) (via I97.-), T81 — Complications of procedures, not elsewhere classified (via I97.-), T82 — Complications of cardiac and vascular prosthetic devices, implants and grafts (via I97.-), T83 — Complications of genitourinary prosthetic devices, implants and grafts (via I97.-), T84 — Complications of internal orthopedic prosthetic devices, implants and grafts (via I97.-), T85 — Complications of other internal prosthetic devices, implants and grafts (via I97.-), T86 — Complications of transplanted organs and tissue (via I97.-), T87 — Complications peculiar to reattachment and amputation (via I97.-), T88 — Other complications of surgical and medical care, not elsewhere classified (via I97.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 1 Code First instruction: I50 — Heart failure.

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

Related Codes

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Failure, failed”; these codes share that main term but sit in a different category of the Tabular List.

I50.812 — Chronic right heart failure (heart, right, chronic), I50.813 — Acute on chronic right heart failure (heart, right, acute, andchronic), I50.814 — Right heart failure due to left heart failure (biventricular, due to left heart failure), I50.82 — Biventricular heart failure (biventricular), I50.83 — High output heart failure (heart, high output NOS), I50.84 — End stage heart failure (heart, end stage), I50.89 — Other heart failure (heart, specified NEC), I50.9 — Heart failure, unspecified (heart), I67.9 — Cerebrovascular disease, unspecified (cerebrovascular), I70.90 — Unspecified atherosclerosis (heart, arteriosclerotic), J95.821 — Acute postprocedural respiratory failure (respiration, respiratory, postprocedural), J95.822 — Acute and chronic postprocedural respiratory failure (respiration, respiratory, postprocedural, acute and chronic), J96.00 — Acute respiratory failure, unspecified whether with hypoxia or hypercapnia (respiration, respiratory, acute), J96.01 — Acute respiratory failure with hypoxia (respiration, respiratory, acute, with, hypoxia), J96.02 — Acute respiratory failure with hypercapnia (respiration, respiratory, acute, with, hypercapnia), J96.10 — Chronic respiratory failure, unspecified whether with hypoxia or hypercapnia (respiration, respiratory, chronic), J96.11 — Chronic respiratory failure with hypoxia (respiration, respiratory, chronic, with, hypoxia), J96.12 — Chronic respiratory failure with hypercapnia (respiration, respiratory, chronic, with, hypercapnia), J96.20 — Acute and chronic respiratory failure, unspecified whether with hypoxia or hypercapnia (respiration, respiratory, acute andchronic), J96.21 — Acute and chronic respiratory failure with hypoxia (respiration, respiratory, acute andchronic, with, hypoxia), +128 more

Contextual Map

Every relationship of I97.13 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run I97.13 with these 9 related codes in Claim Check

Hierarchy

Use Additional Code

  • I50 — Heart failure[Use Additional Code]: “code to identify the heart failure (I50.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2027

Referenced by Excludes2 notes (14)

Referenced by Code First instructions

  • I50 — Heart failure[Code First]: “heart failure following surgery (I97.13-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2027

Nearest codes (40)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Reference

Index terms and tables, published questions and FAQ, every source behind this page with its release and checksum, the date-of-service check and the complete change history.

Common coding questions

MedCoder editorial

Can I97.13 be billed directly?

No. I97.13 (Postprocedural heart failure) is a non-billable ICD-10-CM category code. A more specific billable subcode must be selected based on clinical documentation.

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder-derived relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder editorial explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 28, 2026 · All releases and sources

Labels on this page: Official source data · MedCoder-derived relationship · MedCoder editorial explanation. How to read the labels · All data sources and release dates · CMS coding rules

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "I97.13 — Postprocedural heart failure." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/i97.13-postprocedural-heart-failure

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Postprocedural heart failure

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027, and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to I97.13 in its code family, with their registry titles.

View all codes in the I97 family