I70.219
BillableAtherosclerosis of native arteries of extremities with intermittent claudication, unspecified extremity
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is I70.219 an HCC code?
Yes. I70.219 maps to Vascular Disease under the V24 model but is not retained in V28.
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 I70.219
For I70.219 to 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 I70.219 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
I70.219 is the ICD-10-CM diagnosis code for atherosclerosis of native arteries of extremities with intermittent claudication, unspecified extremity. Hardening of blood vessels in the legs causing pain or cramping during walking that goes away with rest, but the specific leg is not documented. I70.219 sits in the ICD-10-CM chapter for diseases of the circulatory system (i00-i99), within the section covering diseases of arteries, arterioles and capillaries (i70-i79).
Under the older CMS-HCC V24 model, I70.219 maps to Vascular Disease (HCC 108) with a community, non-dual, aged base RAF weight of 0.297. 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.
Use only when intermittent claudication is documented but the specific extremity (right, left, or bilateral) cannot be determined. Because I70.219 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 I70.219 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use only when intermittent claudication is documented but the specific extremity (right, left, or bilateral) cannot be determined
- •Query the provider if possible to obtain laterality information for more specific coding
Clinical Significance
Atherosclerosis of native arteries of the extremities with intermittent claudication indicates peripheral arterial disease severe enough to cause exertional leg pain due to inadequate blood supply during ambulation. Intermittent claudication significantly impairs functional capacity and quality of life and serves as a clinical marker for systemic atherosclerotic burden with increased risk of myocardial infarction and stroke. Proper documentation of the claudication component is essential as it specifies the clinical severity stage of peripheral arterial disease.
Documentation Requirements
- ✓Documentation of the specific arterial site affected by atherosclerosis
- ✓Documentation that the patient experiences exertional leg pain that is relieved by rest (intermittent claudication)
- ✓Specification that the atherosclerosis involves native (not grafted or bypassed) arteries
- ✓Affected leg laterality must be documented (right, left, bilateral)
- ✓Ankle-brachial index or other objective vascular testing results
- ✓Walking distance or functional limitation details
- ✓Treatment plan including exercise therapy, pharmacotherapy, and consideration for revascularization
Commonly Confused Codes
- •I70.20x — Unspecified atherosclerosis of native arteries of extremities; use when no symptoms such as claudication or rest pain are documented
- •I70.22x — Atherosclerosis of native arteries of extremities with rest pain; use when pain occurs at rest, indicating more severe critical limb ischemia
- •I70.31x — Atherosclerosis of unspecified type of bypass graft of extremities with intermittent claudication; use when the affected vessel is a bypass graft
- •I73.9 — Peripheral vascular disease, unspecified; a less specific alternative that should be avoided when atherosclerosis with claudication is documented
- •M79.604-M79.606 — Pain in leg; use for non-vascular leg pain; do not confuse vascular claudication with musculoskeletal pain