I70.723

HCC Category Mapping

What This Code Means

Hardening and narrowing of bypass grafts in both legs causing pain at rest due to poor blood flow.

Coding Tips

• •Use this code only when atherosclerosis with rest pain is documented in both legs
• •Do not use this code if only one leg is affected; select the appropriate unilateral code instead

Clinical Significance

Atherosclerosis of other type bypass grafts with rest pain (bilateral legs) represents advanced peripheral arterial disease (Fontaine Stage III/Rutherford Category 4) where ischemia is severe enough to cause pain even without exertion. This indicates critical limb ischemia that carries high risk for tissue loss and amputation. Risk adjustment captures this as significant vascular disease reflecting expected resource utilization for vascular surveillance, potential revascularization, and wound prevention.

Documentation Requirements

• ✓Documented atherosclerotic disease of bypass graft(s) — specify graft type (must be 'other type' bypass graft, not autologous vein or nonautologous biological)
• ✓Rest pain explicitly stated — pain at rest in the affected extremity, not just claudication with exertion
• ✓Laterality documented: bilateral legs
• ✓Type of bypass graft documented (e.g., synthetic, composite, or other non-vein/non-biological graft)
• ✓Ankle-brachial index (ABI) or other vascular study results supporting diagnosis when available
• ✓Current treatment plan (e.g., antiplatelet therapy, pain management, vascular surgery consult)

Commonly Confused Codes