I70.421
BillableAtherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, right leg
HCC Category Mapping
V28HCC 264 — Vascular Disease with Complications
0.356V24HCC 108 — Vascular Disease
0.297ESRDHCC 108 — Vascular Disease
0.000What This Code Means
Fatty buildup in a vein graft of the right leg causing pain even at rest, indicating severe blood flow reduction.
Coding Tips
- •Rest pain is a more severe symptom than claudication and indicates critical limb ischemia
- •Confirm documentation explicitly states rest pain and right leg involvement
Clinical Significance
This code captures atherosclerosis in autologous vein bypass grafts with rest pain, indicating critical limb ischemia where blood flow is insufficient even at rest. Rest pain represents Fontaine Stage III peripheral arterial disease and signals impending tissue loss without intervention. This is a significant risk adjustment diagnosis reflecting severe vascular compromise requiring close monitoring and often surgical revascularization.
Documentation Requirements
- ✓Documentation of peripheral arterial disease or atherosclerosis affecting the bypass graft
- ✓Identification of graft type as autologous vein (if autologous vein is confirmed, document the vein source; if type is unknown, document it as unspecified)
- ✓Laterality clearly stated as right leg
- ✓Rest pain explicitly documented as occurring without exertion
- ✓Ankle-brachial index or other vascular studies supporting critical limb ischemia
- ✓Treatment plan addressing the critical limb ischemia
- ✓History of bypass graft surgery with date and indication when available
Commonly Confused Codes
I70.3xx (unspecified type bypass graft codes) — Use I70.3xx when the graft type is not documented; use I70.4xx (autologous vein) only when the graft is confirmed as the patient's own veinI70.5xx (nonautologous biological bypass graft codes) — Use when the graft is a biological material from a donor (cadaveric vein, bovine graft), not the patient's own veinI70.6xx (nonbiological bypass graft codes) — Use for synthetic grafts such as polytetrafluoroethylene or Dacron, not for autologous vein graftsI70.2xx (native artery atherosclerosis codes) — Use for atherosclerosis of native arteries, not bypass grafts; verify whether disease is in the graft or native vessel
Code Hierarchy
└I70Atherosclerosis└I70.4Atherosclerosis of autologous vein bypass graft(s) of the extremities└I70.42Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain└I70.421Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, right leg
└I70.421Atherosclerosis of autologous vein bypass graft(s) of the extremities with rest pain, right leg