I70.223
BillableAtherosclerosis of native arteries of extremities with rest pain, bilateral legs
HCC Category Mapping
V28HCC 264 — Vascular Disease with Complications
0.356V24HCC 108 — Vascular Disease
0.297ESRDHCC 108 — Vascular Disease
0.000What This Code Means
Hardening of blood vessels in both legs causing pain even at rest, indicating severe narrowing of the arteries in both limbs.
Coding Tips
- •Rest pain in bilateral legs represents critical limb ischemia; confirm documentation explicitly states bilateral involvement
- •This is a more severe condition than unilateral rest pain and may require more urgent intervention
Clinical Significance
Atherosclerosis of native arteries with rest pain indicates critical limb ischemia (Fontaine Stage III/Rutherford Category 4), where blood flow is insufficient even at rest. This represents a limb-threatening condition requiring urgent vascular evaluation and intervention to prevent progression to tissue loss or gangrene. Capturing this code accurately reflects disease severity that demands higher levels of care and resource allocation.
Documentation Requirements
- ✓Clinical diagnosis of peripheral atherosclerosis explicitly documented by the provider
- ✓Specification of the affected vessel type (native arteries)
- ✓Laterality clearly documented (bilateral legs)
- ✓Documentation of rest pain — ischemic pain occurring at rest, typically in the forefoot, worsening with elevation and improving with dependency
- ✓Vascular assessment findings such as ankle-brachial index (ABI), pulse examination, or imaging results supporting the diagnosis
- ✓Current treatment plan including medication management, pain control, and any planned vascular interventions
- ✓Documentation distinguishing rest pain from claudication (exertional pain) or neuropathic pain
Commonly Confused Codes
I70.3xx (bypass graft series) — Use I70.3xx when atherosclerosis involves a bypass graft rather than native arteries; the graft type must be specified when knownI70.211-I70.219 (native arteries with intermittent claudication) — Claudication is exertional leg pain that resolves with rest, while rest pain occurs even without activity and indicates more severe ischemiaI70.231-I70.25 (native arteries with ulceration) — Use ulceration codes when tissue breakdown is present in addition to or instead of rest pain; if both rest pain and ulceration exist, code the ulcerationI70.261-I70.269 (native arteries with gangrene) — If tissue necrosis is present, gangrene codes take precedence over rest pain codesI73.9 (Peripheral vascular disease, unspecified) — Avoid this nonspecific code when atherosclerotic peripheral arterial disease with rest pain can be documented specifically
Code Hierarchy
└I70Atherosclerosis└I70.2Atherosclerosis of native arteries of the extremities└I70.22Atherosclerosis of native arteries of extremities with rest pain└I70.223Atherosclerosis of native arteries of extremities with rest pain, bilateral legs
└I70.223Atherosclerosis of native arteries of extremities with rest pain, bilateral legs