Is I28.0 a billable ICD-10-CM code?

Yes. I28.0 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does I28.0 sit in the tabular list?

Diseases of the circulatory system (I00-I99), in the block Pulmonary heart disease and diseases of pulmonary circulation (I26-I28).

What cannot be coded together with I28.0?

I28.0 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

I28.0

I28.0 — Arteriovenous fistula of pulmonary vessels

Billable / specific codeICD-10-CM

I28.0 is a billable, specific ICD-10-CM code for arteriovenous fistula of pulmonary vessels. It is valid for submission on a claim.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

congenital arteriovenous fistula (Q25.72)

Risk adjustment

I28.0 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

HCC 226 Heart Failure, Except End Stage and Acute0.360 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.

Medicare coverage

I28.0 is named in 15 Medicare coverage policies — 15 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A52850Billing and Coding: Cardiac Catheterization and Coronary Angiography
A52868Billing and Coding: Transesophageal Echocardiography (TEE)
A56500Billing and Coding: Cardiac Catheterization and Coronary Angiography
A56505Billing and Coding: Transesophageal Echocardiography (TEE)

How I28.0 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to I28.0.

Shunt›arteriovenous, pulmonary(acquired)
Fistula›arteriovenous›pulmonary
Fistula›pulmonary›arteriovenous
Aneurysm›arteriovenous›acquired›pulmonary
Aneurysm›pulmonary›arteriovenous›acquired

Related codes at this level

Codes that share I28. If I28.0 is not quite right, the correct code is usually one of these.

Questions about I28.0

Is I28.0 a billable ICD-10-CM code?: Yes. I28.0 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does I28.0 sit in the tabular list?: Diseases of the circulatory system (I00-I99), in the block Pulmonary heart disease and diseases of pulmonary circulation (I26-I28).
What cannot be coded together with I28.0?: I28.0 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.