Peripheral Vascular Disease HCC Coding Guide
Peripheral Vascular Disease (e.g. I70.261) 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 383 (Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle) and HCC 264 (Vascular Disease with Complications) when the documentation supports those manifestations.
Complete HCC coding guide for Peripheral Vascular Disease (I73.x) including ICD-10 to HCC mapping, V28 RAF weights, claudication documentation, and PAD coding.
Medically reviewed by Jess P., CPC · Reviewed: May 9, 2026 · Updated for CMS-HCC V28 and FY2026 ICD-10-CM
Quick Facts
HCC Categories
HCC 263, Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene
HCC 383, Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle
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
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 | No | 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 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 |
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.
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 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). Importantly, the ulceration codes (I70.23x to I70.25) are dual-mapping: a single code adds HCC 263 plus HCC 383 (Chronic Ulcer of Skin, RAF 0.646) as a separate manifestation category, so the chronic ulcer is captured on top of the vascular disease. Claudication-only and unspecified I73.9 codes carry no V28 payment HCC, which is the biggest shift for coders to internalize.
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 May 9, 2026.
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