I70.221

Billable

Atherosclerosis of native arteries of extremities with rest pain, right leg

HCC Category Mapping

V28HCC 264 — Vascular Disease with Complications

0.356

V24HCC 108 — Vascular Disease

0.297

ESRDHCC 108 — Vascular Disease

0.000

What This Code Means

This condition occurs when fatty deposits build up in the arteries of the right leg, narrowing blood flow and causing pain even when the person is resting or not moving. It indicates moderate to severe atherosclerotic disease affecting the leg's blood supply.

Coding Tips

•Ensure documentation specifies 'rest pain' as the symptom, distinguishing it from claudication (pain with activity), as this affects severity coding
•Verify laterality is documented as right leg; if bilateral disease exists, code both sides separately with appropriate laterality indicators (I70.221 for right, I70.222 for left)

Clinical Significance

Atherosclerosis of native arteries of the extremities with rest pain represents critical limb ischemia, a severe and limb-threatening stage of peripheral arterial disease where blood supply is insufficient even at rest. This condition carries a high risk of tissue loss, gangrene, and amputation, and typically requires urgent vascular intervention such as revascularization. In the V28 model, this code maps to HCC 264 with a RAF weight of 0.356, reflecting the significantly higher resource utilization and clinical complexity of critical limb ischemia compared to less severe peripheral arterial disease.

Documentation Requirements

✓Documentation of the specific arterial site affected by atherosclerosis
✓Documentation that the patient experiences ischemic pain at rest, not just during exertion
✓Specification that the atherosclerosis involves native (not grafted or bypassed) arteries
✓Affected leg laterality must be documented (right, left, bilateral)
✓Hemodynamic assessment results (ankle-brachial index, toe pressures, or transcutaneous oxygen measurements)
✓Assessment for tissue loss, ulceration, or gangrene (which would require a different, more specific code)
✓Vascular surgery or interventional radiology consultation and revascularization plan

Commonly Confused Codes

I70.21x — Atherosclerosis of native arteries of extremities with intermittent claudication; use when pain occurs only with exertion, not at rest I70.23x-I70.25x — Atherosclerosis of native arteries with ulceration or gangrene; use when tissue loss is present in addition to rest pain I70.32x — Atherosclerosis of unspecified type of bypass graft of extremities with rest pain; use when the affected vessel is a bypass graft, not a native artery I70.20x — Unspecified atherosclerosis of native arteries of extremities; use when no symptoms are documented; rest pain indicates much more severe disease I96 — Gangrene, not elsewhere classified; do not use when gangrene is specifically associated with atherosclerosis of extremities, which has its own codes

Code Hierarchy

└I70Atherosclerosis └I70.2Atherosclerosis of native arteries of the extremities └I70.22Atherosclerosis of native arteries of extremities with rest pain └I70.221Atherosclerosis of native arteries of extremities with rest pain, right leg

└I70.221Atherosclerosis of native arteries of extremities with rest pain, right leg