Condition guide
Peripheral Vascular Disease HCC Coding Guide
Peripheral Vascular Disease (e.g. I70.25) maps to HCC 263 (Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene) under the CMS-HCC V28 risk adjustment model, with a community, non-dual, aged RAF weight of 1.118; V28 reached 100% phase-in for payment year 2026. I70.211, atherosclerosis of native arteries of extremities with intermittent claudication, right leg, is non-HCC under V28. It can also map to HCC 264 (Vascular Disease with Complications) when the documentation supports those manifestations.
Quick Facts
HCC Categories
HCC 263, Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene
HCC 264, Vascular Disease with Complications
RAF Weight Range
0.455 to 1.118
Community, non-dual, aged (V28)
Model
CMS-HCC V28 (PY2026, 100% phase-in)
5 ICD-10 codes map to payment HCCs
How coders write it
Chart notes, problem lists, and queries rarely spell out Peripheral Vascular Disease. The shorthand you will actually see:
Whatever the note calls it, the payment question is the same: how the ICD-10-CM code resolves to a payment HCC.
What HCC category does Peripheral Vascular Disease map to under V28?
Peripheral vascular disease (PVD), also called peripheral artery disease (PAD), is a high-yield condition under CMS-HCC V28, but only the more severe atherosclerotic presentations carry a payment HCC. Under V28 the qualifying code is driven by clinical severity. Atherosclerosis of the extremities with rest pain (I70.22x) maps to HCC 264 (Vascular Disease with Complications), with ulceration (I70.23x to I70.25) it maps to HCC 263 (Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene), and with gangrene (I70.26x) it also maps to HCC 263. Intermittent claudication codes (I70.21x) and unspecified PVD (I73.9) do not map to a V28 payment HCC, so capturing documented severity and laterality is essential.
ICD-10 to HCC Mapping
| ICD-10 Code | Description | Billable | HCC Mapping |
|---|---|---|---|
| I70.211 | Atherosclerosis of native arteries of extremities with intermittent claudication, right leg | Yes | No HCC (not risk-adjusting under V28) |
| I70.212 | Atherosclerosis of native arteries of extremities with intermittent claudication, left leg | Yes | No HCC (not risk-adjusting under V28) |
| I70.219 | Atherosclerosis of native arteries of extremities with intermittent claudication, unspecified leg | Yes | No HCC (not risk-adjusting under V28) |
| I70.221 | Atherosclerosis of native arteries of extremities with rest pain, right leg | Yes | HCC 264 |
| I70.25 | Atherosclerosis of native arteries of other extremities with ulceration | Yes | HCC 263 |
| I73.9 | Peripheral vascular disease, unspecified | Yes | No HCC (not risk-adjusting under V28) |
| I70.209 | Unspecified atherosclerosis of native arteries of extremities, unspecified extremity | Yes | No HCC (not risk-adjusting under V28) |
| I70.231 | Atherosclerosis of native arteries of right leg with ulceration of thigh | Yes | HCC 263 |
| I70.261 | Atherosclerosis of native arteries of extremities with gangrene, right leg | Yes | HCC 263 |
| I70.262 | Atherosclerosis of native arteries of extremities with gangrene, left leg | Yes | HCC 263 |
RAF weights are community, non-dual, aged base coefficients from the CMS-HCC V28 model (PY2026). Verify against the latest CMS rate announcement for payment calculations.
HCC Buddy maps Peripheral Vascular Disease from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coder workflow notes
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Documentation Tips
Document the specific etiology: atherosclerotic peripheral vascular disease (I70.2x) vs. other peripheral vascular disease (I73.x), only atherosclerotic PVD maps to the HCC.
Specify the laterality (right, left, bilateral) and the vascular bed involved (native arteries, bypass graft, stent).
Document the clinical severity: intermittent claudication, rest pain, ulceration, or gangrene, each maps to different code extensions.
Record ABI (ankle-brachial index) values to support the diagnosis and severity documentation.
Document any surgical history: bypass grafts, stent placement, endarterectomy, these affect code selection from the I70 category.
Note tobacco use status as it is relevant to disease progression and management documentation.
MEAT documentation examples for Peripheral Vascular Disease
A diagnosis only counts toward risk adjustment when the encounter note shows the provider engaged with it. These are the kinds of entries that satisfy the MEAT documentation standard for Peripheral Vascular Disease:
MMonitor
“ABI 0.62 right and 0.68 left, both down from prior measurement.”
“Walking distance to claudication now half a block, from two blocks.”
“Wound photos compared: left heel ulcer 1.2 cm, was 1.8 cm.”
EEvaluate
“Exam: absent dorsalis pedis and posterior tibial pulses, right foot; hair loss to mid-calf.”
“Dependent rubor with forefoot rest pain, worse at night.”
“Arterial duplex: 80 percent stenosis of the right superficial femoral artery.”
AAssess
“PAD with ischemic rest pain, right leg; limb-threat risk discussed.”
“Atherosclerosis with non-healing left heel ulcer.”
“Claudication, stable on cilostazol and a walking program.”
TTreat
“Referred to vascular surgery for angiography.”
“Started cilostazol 100 mg twice daily; continue statin and antiplatelet.”
“Wound care twice weekly; offloading boot fitted.”
Common Coding Mistakes
Coding I73.9 (peripheral vascular disease, unspecified) instead of I70.2x (atherosclerosis of extremities), I73.9 does NOT map to a payment HCC.
Failing to document laterality, resulting in 'unspecified leg' codes when the affected side is documented in the record.
Not capturing the severity (claudication vs. rest pain vs. ulceration) which provides important clinical specificity.
Missing the opportunity to code atherosclerosis of bypass grafts (I70.4-I70.7) when the patient has prior vascular surgery.
V24 to V28 Changes
V28 ties peripheral vascular disease payment to documented severity rather than a single broad vascular category. Codes for atherosclerosis with rest pain land in HCC 264 (community non-dual aged RAF 0.455), while ulceration or gangrene codes land in HCC 263 (RAF 1.118). One point coders get wrong: the ulceration and gangrene codes (I70.23x to I70.26x) do not stack two categories. HCC 263 sits above the vascular disease category HCC 264 and the chronic-ulcer category HCC 383 in the V28 hierarchy and supersedes them, so a single atherosclerosis-with-ulceration code resolves to HCC 263 alone, not HCC 263 plus a separate ulcer HCC. Claudication-only and unspecified I73.9 codes carry no V28 payment HCC, which is the biggest shift for coders to internalize: both paid the V24 vascular disease category HCC 108 at 0.288, and V28 zeroed them out.
| Aspect | V24 (through PY2025) | V28 (PY2026) |
|---|---|---|
| Intermittent claudication (I70.211, I70.219) | HCC 108, Vascular Disease, RAF 0.288 | No payment HCC |
| Unspecified PVD (I73.9) | HCC 108, RAF 0.288 | No payment HCC |
| Rest pain (I70.221) | HCC 108, RAF 0.288 | HCC 264, Vascular Disease with Complications, RAF 0.455 |
| Ulceration (I70.231, I70.25) | HCC 106, Atherosclerosis of the Extremities with Ulceration or Gangrene, RAF 1.488 | HCC 263, RAF 1.118 |
| Gangrene (I70.261, I70.262) | HCC 106, RAF 1.488 | HCC 263, RAF 1.118 |
RAF values are community, non-dual, aged base coefficients for each model's payment year. To see what these weights do to a real patient total, run the codes through the RAF score calculator.
Peripheral Vascular Disease coding FAQs
Does I73.9 risk-adjust under V28?
No. I73.9 (peripheral vascular disease, unspecified) mapped to V24 HCC 108 at 0.288 and carries no payment HCC under V28. It is one of the most commonly coded diagnoses that lost payment status in the model transition. When the record documents atherosclerosis with rest pain, ulceration, or gangrene, the specific I70.2x code is what restores the capture.
Is claudication an HCC in 2026?
No. The intermittent claudication codes (I70.21x) do not map to a payment HCC under V28, though they paid HCC 108 under V24. Payment now starts at rest pain (I70.22x, HCC 264) and climbs to ulceration or gangrene (I70.23x to I70.26x, HCC 263). Documented severity is the entire payment story for PAD.
What is the RAF weight for atherosclerosis with gangrene?
I70.26x codes map to V28 HCC 263 (Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene) with a community, non-dual, aged RAF weight of 1.118, one of the highest-value chronic condition categories in the model. The V24 counterpart, HCC 106, paid 1.488.
Related Conditions
Related references
Sources
RAF weights are community, non-dual, aged base coefficients from the CMS-HCC V28 model (PY2026). Verify against the latest CMS Rate Announcement for payment.
Verified current to CMS-HCC V28, payment year 2026 — last reviewed July 16, 2026.
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