I67.3
BillableProgressive vascular leukoencephalopathy
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is I67.3 an HCC code?
Yes. I67.3 maps to Dementia, Mild or Unspecified under the CMS-HCC V28 risk adjustment model (and Dementia Without Complication under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for I67.3
For I67.3to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed I67.3 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
I67.3 is the ICD-10-CM diagnosis code for progressive vascular leukoencephalopathy. A progressive disease affecting the white matter of the brain due to blood vessel problems, leading to gradual loss of brain function. I67.3 sits in the ICD-10-CM chapter for diseases of the circulatory system (i00-i99), within the section covering cerebrovascular diseases (i60-i69).
Under the CMS-HCC V28 risk adjustment model, I67.3 maps to Dementia, Mild or Unspecified (HCC 127) with a community, non-dual, aged base RAF weight of 0.341. Under the older CMS-HCC V24 model, I67.3 maps to Dementia Without Complication (HCC 52) with a community, non-dual, aged base RAF weight of 0.346. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
This is a rare condition; ensure diagnosis is clearly documented by the provider. Because I67.3 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for I67.3 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a rare condition; ensure diagnosis is clearly documented by the provider
- •Document progression and any associated symptoms or complications
Clinical Significance
Progressive vascular leukoencephalopathy (Binswanger disease) is a chronic progressive cerebrovascular condition causing white matter degeneration due to small vessel disease. It leads to progressive cognitive decline, gait disturbances, and urinary incontinence, often in the context of long-standing hypertension. This condition reflects significant underlying cerebrovascular disease burden and is important for risk adjustment as it indicates ongoing neurological deterioration.
Documentation Requirements
- ✓Provider documentation explicitly naming progressive vascular leukoencephalopathy or Binswanger disease
- ✓MRI or CT findings showing extensive white matter changes consistent with small vessel ischemic disease
- ✓Clinical symptoms supporting the diagnosis (cognitive decline, gait disturbance, urinary incontinence)
- ✓Documentation of underlying vascular risk factors, particularly chronic hypertension
- ✓Differentiation from other causes of white matter disease (multiple sclerosis, radiation injury)
- ✓Assessment of current functional status and disease progression
Commonly Confused Codes
- •I67.2 — Cerebral atherosclerosis; a broader category of cerebrovascular disease without the specific white matter pattern
- •F01.5x — Vascular dementia; code separately if dementia is documented as a result of the leukoencephalopathy
- •G93.49 — Other encephalopathy; nonvascular causes of encephalopathy
- •I67.82 — Cerebral ischemia; more acute/transient than progressive leukoencephalopathy