Peripheral Vascular Disease HCC Coding Guide
Complete HCC coding guide for Peripheral Vascular Disease (I73.x) including ICD-10 to HCC mapping, V28 RAF weights, claudication documentation, and PAD coding.
Quick Facts
HCC Categories
HCC 238 — Atherosclerosis of Arteries of the Extremities
RAF Weight Range
0.288
Community, non-dual, aged (V28)
Model
CMS-HCC V28 (PY2026 — 100% phase-in)
9 ICD-10 codes map to payment HCCs
Overview
Peripheral vascular disease (PVD), also known as peripheral artery disease (PAD), affects approximately 8.5 million Americans and is a significant HCC condition under CMS-HCC V28. PVD maps to HCC 238 (Atherosclerosis of Arteries of the Extremities) when coded with atherosclerotic disease codes (I70.2x). Accurate coding requires documenting the specific arterial site, laterality, severity (claudication, rest pain, ulceration, gangrene), and any associated procedures. The distinction between atherosclerotic PVD (I70) and non-atherosclerotic peripheral vascular conditions (I73) is critical for HCC mapping. Coders must ensure the specific manifestation — intermittent claudication, rest pain, or tissue loss — is captured with the correct 5th and 6th character specificity.
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 | HCC 238 |
| I70.212 | Atherosclerosis of native arteries of extremities with intermittent claudication, left leg | Yes | HCC 238 |
| I70.219 | Atherosclerosis of native arteries of extremities with intermittent claudication, unspecified leg | Yes | HCC 238 |
| I70.221 | Atherosclerosis of native arteries of extremities with rest pain, right leg | Yes | HCC 238 |
| I70.25 | Atherosclerosis of native arteries of other extremities with ulceration | No | HCC 238 |
| I73.9 | Peripheral vascular disease, unspecified | Yes | No HCC |
| I70.209 | Unspecified atherosclerosis of native arteries of extremities, unspecified extremity | Yes | HCC 238 |
| I70.231 | Atherosclerosis of native arteries of right leg with ulceration of thigh | Yes | HCC 238 |
| I70.261 | Atherosclerosis of native arteries of extremities with gangrene, right leg | Yes | HCC 238 |
| I70.262 | Atherosclerosis of native arteries of extremities with gangrene, left leg | Yes | HCC 238 |
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.
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.
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 maps atherosclerotic PVD to HCC 238 (Atherosclerosis of Arteries of the Extremities), replacing V24 HCC 108 (Vascular Disease). The V28 recalibration separated atherosclerotic PVD from other vascular conditions, making it important to use I70.2x codes rather than the non-specific I73.9. Non-atherosclerotic peripheral vascular disease codes (I73.x) were dropped from payment HCCs in V28, emphasizing the need for specific atherosclerotic disease documentation.
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