I73.9 Does Not Map in V28. Rest Pain I70.22- Is HCC 264. Ulcer or Gangrene Is HCC 263.

If you searched I73.9 next to HCC, PVD, or V28, you are looking at one of the most common peripheral vascular leftovers under CMS-HCC V28 for payment year 2026. I73.9 is billable peripheral vascular disease, unspecified. It does not map to a CMS-HCC V28 payment HCC.

Moving the chart to I70.209 (unspecified atherosclerosis of native arteries of extremities) alone also does not create payment. That trap already has its own desk: I70.209 does not map in V28. Intermittent claudication codes such as I70.212 are likewise not mapped under the PY2026 V28 file.

The severity that does map starts at rest pain. I70.221 (rest pain, right leg) maps to V28 HCC 264 (Vascular Disease with Complications) with a source-labeled community non-dual aged (CNA) reference of 0.455. Ulceration codes such as I70.235 map to HCC 263 (CNA 1.118) and HCC 383 (CNA 0.646). Gangrene codes such as I70.261 map to HCC 263.

This page is the leftover-style I73.9 / PAD map desk for that leak. It is not a rewrite of the I70.209 PAD desk, the ulcer HCC coding desk, or the E11.52 / I70.261 sequencing desk.

Desk table: verified maps and no-maps (2026-09-21)

Coefficients are source-labeled CNA references from the live cards and the HCC 264 / HCC 263 / HCC 383 hubs. Not member totals. Hierarchy still applies: HCC 263 supersedes HCC 264 and HCC 383 when a higher category in the same disease group is also present. Mapped I70.2* payment rows above carry the CSV age edit `age >= 15`.

What I73.9 is (and is not)

I73.9 means peripheral vascular disease, unspecified. Inclusion terms include intermittent claudication and peripheral angiopathy NOS when the chart does not support a more specific arterial diagnosis. The code book also points away from atherosclerosis of the extremities when that etiology is documented (prefer the I70.2 family).

Billable does not mean risk-adjusted. Under PY2026 community V28 payment, I73.9 has no payment HCC. Do not invent a V24 map for current-year non-PACE scoring. Select the historical period on the live card if you need older model context.

ESRD / PACE may still show a vascular category for some of these codes with member context. That is not a CMS-HCC V28 community payment map. Keep the models separate.

Why I70.209 and claudication still do not pay

Coders often fix I73.9 by switching to "atherosclerosis" without severity. I70.209 names native-artery atherosclerosis but remains unspecified for symptoms and laterality. Under V28 it has no payment row. See the dedicated I70.209 desk.

Intermittent claudication (I70.21x) documents exertional pain relieved by rest. It is clinically important and billable. It still has no PY2026 V28 payment row. Claudication is not rest pain.

When rest pain, ulcer, or gangrene change the map

If the provider documents atherosclerosis of native arteries with rest pain, use the I70.22x laterality codes (example: I70.221). Those map to HCC 264 (CNA 0.455).

If the chart supports ulceration due to native-artery atherosclerosis, use I70.23x / I70.24x / I70.25 (site and laterality as documented). Those map to HCC 263 (CNA 1.118) and HCC 383 (CNA 0.646) in the PY2026 file. Hierarchy can remove the lower category when both apply.

If the chart supports gangrene due to native-artery atherosclerosis, use I70.26x. Those map to HCC 263 (CNA 1.118).

Pick the path from the documentation:

1. PVD / PAD labeled only as unspecified → I73.9 (no V28 payment map). Query when the note supports atherosclerosis and severity.

2. Atherosclerosis of native arteries, symptoms not documented → I70.20x (example I70.209). Still no V28 payment map.

3. Atherosclerosis with intermittent claudication only → I70.21x. Still no V28 payment map.

4. Atherosclerosis with rest pain → I70.22x → HCC 264 (CNA 0.455).

5. Atherosclerosis with ulceration → I70.23x / 24x / 25 → HCC 263 (+ HCC 383 in the file).

6. Atherosclerosis with gangrene → I70.26x → HCC 263.

7. Do not invent atherosclerosis, rest pain, ulcer, or gangrene for RAF. Query when findings support it.

Rest pain is ischemic pain at rest, not claudication. Ulceration and gangrene outrank rest pain when tissue loss is documented. Prefer native-artery vs bypass-graft series based on the vessels documented.

MEAT for HCC 264 / 263 capture

A mapped code still needs monitoring, evaluation, assessment, or treatment in the eligible encounter year. A problem-list row that says "PVD" or "PAD" from last year does not carry HCC 264 or 263 forward by itself.

For I70.22x (HCC 264) and I70.23x / 24x / 25 / 26x (HCC 263), the note should support:

MEAT is a review mnemonic, not a universal CMS coding rule. Follow the applicable coding, encounter, program, and payer requirements. See MEAT and problem lists.

Audit and query traps

1. Leaving supported atherosclerotic PAD on I73.9 and expecting an HCC because "PVD is vascular."

2. Moving I73.9 to I70.209 and assuming atherosclerosis alone pays under V28. It does not.

3. Coding I70.21x claudication and treating it like rest pain (HCC 264). Claudication does not map.

4. Inventing rest pain, ulceration, or gangrene from a vague "PAD" note without provider confirmation.

5. Using rest-pain codes when ulceration or gangrene is documented (understating severity).

6. Confusing ESRD vascular mapping with CMS-HCC V28 community payment.

7. Skipping MEAT for a historical PAD label with no current assessment or treatment.

8. Ignoring hierarchy: when HCC 263 also applies, HCC 264 and HCC 383 can be superseded.

9. Mixing diabetic angiopathy with gangrene sequencing into this leftover desk. Cross-link the E11.52 / I70.261 sequencing desk when both etiologies appear.

10. Rewriting this trap into the I70.209 or ulcer overview posts. Cross-link those; keep this I73.9 map walk here.

Two-minute check

1. Is the documentation only unspecified PVD? Expect I73.9, no V28 payment map.

2. Is it unspecified native-artery atherosclerosis without symptoms? Expect I70.20x, still no V28 payment map. See the I70.209 desk.

3. Claudication only? Expect I70.21x, still no V28 payment map.

4. Rest pain with native-artery atherosclerosis? Expect I70.22x → HCC 264 (CNA 0.455).

5. Ulceration? Expect I70.23x / 24x / 25 → HCC 263 (and HCC 383 in the file).

6. Gangrene? Expect I70.26x → HCC 263.

7. MEAT this year. Look the exact code up on its card or /icd10-to-hcc.

Related

Disclaimer

By the HCC Buddy Coding Team. V28 mappings from the cited live code pages, the HCC 264 / 263 / 383 hubs, and `ICD10_CC_mappings_CMS_HCC_2026_v28.csv`, current as of September 21, 2026. Coefficients are source-labeled references, not member totals. Not medical advice. Do not code from this recap. Not a Coding Clinic reprint. Not a rewrite of the I70.209 PAD desk, ulcer-hcc-coding-desk-guide, e11-52-i70-261-sequencing-desk, I25.10 CAD desk, I10-I13, E13, E66.2, F32.9, the V28 PDF list desk, or D59.31.