I70.428

HCC Category Mapping

What This Code Means

Hardening of arteries in a vein graft used to bypass blocked blood vessels in the legs or arms, causing pain at rest in a limb other than the main ones listed.

Coding Tips

• •This code requires documentation specifying which extremity is affected (not right leg, left leg, right arm, or left arm)
• •Rest pain indicates significant arterial insufficiency and should be clearly documented in the clinical record

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)
• ✓Specification of which extremity is affected (upper extremity or other non-lower-extremity site)
• ✓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