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 CMS-HCC V28. Its source-labeled community non-dual aged reference coefficient is 1.118. This is not a member total; full contribution depends on hierarchy, cleanup, interactions, member context, and model year. 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) and HCC 383 (Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle) 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
HCC 383, Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle
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), maps by documented severity under CMS-HCC V28. Rest-pain codes such as I70.221 map to HCC 264. The official CY2026 final mapping lists both HCC 263 and HCC 383 for ulceration codes such as I70.231 and I70.25, while gangrene codes such as I70.261 map to HCC 263. Preserve every source mapping in the lookup. During scoring, HCC 263 supersedes HCC 383 in the V28 hierarchy when both are present. The final result still depends on the complete diagnosis set, cleanup rules, interactions, age, and member segment.
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 + HCC 383 |
| 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 + HCC 383 |
| 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 |
Displayed numbers are source-labeled community non-dual aged reference coefficients from CMS-HCC V28, not member totals.
Verify Peripheral Vascular Disease against 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
These examples organize documentation review using the MEAT review mnemonic for Peripheral Vascular Disease. Follow the applicable coding, encounter, program and payer requirements; these examples do not establish reportability on their own.
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 mapping to documented severity rather than one broad vascular category. Rest-pain codes map to HCC 264. The official CY2026 final mapping lists HCC 263 and HCC 383 for I70.231 and I70.25, while gangrene codes map to HCC 263. Preserve both ulceration mappings in the lookup result. During scoring, HCC 263 supersedes HCC 383 in the V28 hierarchy when both are present. Claudication-only and unspecified I73.9 codes have no payable V28 mapping. The historical PY2025 V24 reference mapped both to HCC 108. Coefficients and the final score still depend on the complete diagnosis set and member segment.
| 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) | Historical PY2025 mapping: HCC 106 | Current CY2026 mapping: HCC 263 and HCC 383; HCC 263 supersedes HCC 383 in the V28 hierarchy |
| Gangrene (I70.261, I70.262) | HCC 106, RAF 1.488 | HCC 263, RAF 1.118 |
These values are community, non-dual, aged code-level coefficient references for each model's payment year, not full member scores. For CMS-HCC V28 PY2026 member scoring with complete context, open the RAF Calculator. No score is shown unless every required source and calculation check passes.
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
Displayed numbers are source-labeled community non-dual aged reference coefficients from CMS-HCC V28, not member totals.
Verified current to CMS-HCC V28, payment year 2026 — last reviewed September 5, 2026.
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