I70.432 ICD-10-CM Code: Atherosclerosis of autologous vein bypass graft(s) of the right leg with ulceration of calf

Code

I70.432

Description

Atherosclerosis of autologous vein bypass graft(s) of the 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 I70.432 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for I70.432

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for I70.432 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •Distinguish between calf ulceration and other lower leg locations to ensure correct code selection
• •Document whether the ulcer is healing or worsening to support clinical decision-making

Clinical Significance

This code identifies atherosclerosis in autologous vein bypass grafts with ulceration of calf, indicating significant peripheral arterial insufficiency causing tissue breakdown. Ulceration complicating bypass graft atherosclerosis signals graft stenosis or failure with inadequate distal perfusion, requiring wound care management and potential revascularization. Accurate capture matters for risk adjustment as it reflects the progression from stable peripheral arterial disease to limb-threatening ischemia.

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
• ✓Ulcer site specifically documented (in this case, calf)
• ✓Ulcer severity, size, and depth documented (consider Wound, Ischemia, and foot Infection classification or similar staging)
• ✓Causal link between atherosclerotic graft disease and the ulceration must be established in the documentation
• ✓Current wound care plan and treatment documented
• ✓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 vein
• •I70.5xx (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 vein
• •I70.6xx (nonbiological bypass graft codes): Use for synthetic grafts such as polytetrafluoroethylene or Dacron, not for autologous vein grafts
• •I70.2xx (native artery atherosclerosis codes): Use for atherosclerosis of native arteries, not bypass grafts; verify whether disease is in the graft or native vessel
• •L97.xxx (non-pressure chronic ulcer of lower limb): Use L97 as an additional code for ulcer severity/laterality, but the primary etiology code should be the I70 code when atherosclerosis is the underlying cause

Child Codes