I70.263

Billable

Atherosclerosis of native arteries of extremities with gangrene, bilateral legs

HCC Category Mapping

V28HCC 263 — Atherosclerosis of the Extremities with Ulceration or Gangrene

0.742

V24HCC 106 — Atherosclerosis of the Extremities with Ulceration or Gangrene

0.860

ESRDHCC 106 — Atherosclerosis of the Extremities with Ulceration or Gangrene

0.000

What This Code Means

Hardening of arteries affecting both legs with tissue death (gangrene) in both extremities due to severe blood flow obstruction.

Coding Tips

•Bilateral gangrene is a critical condition; ensure documentation confirms involvement of both legs
•Consider whether amputation or other interventions are documented as this indicates advanced disease

Clinical Significance

Atherosclerosis of native arteries with gangrene represents the most severe stage of peripheral arterial disease (Fontaine Stage IV/Rutherford Category 5-6), indicating tissue death due to critical limb ischemia. This diagnosis carries extremely high morbidity with significant risk of amputation, sepsis, and mortality, requiring urgent vascular intervention. Accurate capture is essential for risk adjustment as it reflects the highest severity of peripheral vascular disease and drives substantial resource utilization.

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)
✓Explicit documentation of gangrene — type (dry or wet), extent, and anatomic location
✓Confirmation that gangrene is due to atherosclerotic peripheral arterial disease
✓Vascular assessment findings documenting the severity of arterial insufficiency
✓Current treatment plan including surgical consultation, debridement, revascularization, or amputation considerations
✓Assessment for sepsis or systemic infection if wet gangrene is present

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 I70.231-I70.25 (native arteries with ulceration) — Gangrene codes represent more severe tissue damage than ulceration alone; do not downcode to ulceration when gangrene is documented I70.221-I70.229 (native arteries with rest pain) — Rest pain codes are insufficient when gangrene has developed; gangrene codes already encompass the lower severity stages I96 (Gangrene, not elsewhere classified) — Do not use this nonspecific gangrene code when the etiology is atherosclerotic peripheral arterial disease R02 (Gangrene, not elsewhere classified — legacy) — This code is no longer valid; use the combination code that identifies both the atherosclerosis and gangrene E11.52 (Type 2 diabetes with diabetic peripheral angiopathy with gangrene) — Use this code when gangrene is attributed to diabetic peripheral angiopathy rather than primary atherosclerosis

Code Hierarchy

└I70Atherosclerosis └I70.2Atherosclerosis of native arteries of the extremities └I70.26Atherosclerosis of native arteries of extremities with gangrene └I70.263Atherosclerosis of native arteries of extremities with gangrene, bilateral legs

└I70.263Atherosclerosis of native arteries of extremities with gangrene, bilateral legs