I70.232 ICD-10-CM Code: Atherosclerosis of native arteries of right leg with ulceration of calf

Code

I70.232

Description

Atherosclerosis of native arteries of right leg with ulceration of calf

HCC (V28)

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

RAF reference coefficient

HCC 263: 1.118; HCC 383: 0.646

Billable

Yes

Payment year

2026

HCC Category Mapping

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work I70.232 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for I70.232

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for I70.232 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •Verify the ulceration is specifically located on the calf (not thigh or other location) of the right leg
• •Document the stage and characteristics of the ulcer to support medical necessity for treatment

Clinical Significance

Atherosclerosis of native arteries with ulceration indicates severe peripheral arterial disease (Fontaine Stage IV/Rutherford Category 5) where impaired blood flow has caused tissue breakdown. These arterial ulcers require specialized wound care, vascular assessment, and often revascularization to promote healing and prevent amputation. This combination code captures both the underlying vascular disease and the ulcerative complication, reflecting the increased care complexity and resource needs.

Documentation Requirements

• ✓Clinical diagnosis of peripheral atherosclerosis explicitly documented by the provider
• ✓Specification of the affected vessel type (native arteries)
• ✓Laterality clearly documented (right leg)
• ✓Documentation of the ulcer location (calf) with description of size, depth, and wound characteristics
• ✓Confirmation that the ulcer is arterial in etiology (as opposed to venous, diabetic neuropathic, or pressure ulcer)
• ✓Wound assessment details including wound bed description, drainage, presence of infection, and staging if applicable
• ✓Vascular assessment findings (ankle-brachial index, pulse examination, or arterial Doppler studies) supporting ischemic etiology
• ✓Current wound care and vascular treatment plan

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 known
• •I70.221-I70.229 (native arteries with rest pain): Use rest pain codes only when there is no ulceration or gangrene present; ulceration codes include the rest pain component
• •L97.x (Non-pressure chronic ulcer of lower limb): L97 codes describe ulcers not specified as due to atherosclerosis; use I70.23x-I70.25 when the ulcer is clearly arterial in etiology. An additional L97 code may be assigned for ulcer severity
• •I70.261-I70.269 (native arteries with gangrene): If gangrene is present along with ulceration, code the gangrene category as it represents greater severity
• •E11.621 (Type 2 diabetes mellitus with foot ulcer): Diabetic foot ulcers are coded differently; if both atherosclerosis and diabetes contribute, both conditions should be coded

Child Codes