What is ICD-10 code I70.728?

I70.728 is the ICD-10-CM diagnosis code for Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, other extremity. Hardening and narrowing of a bypass graft in an extremity other than the legs (such as arm) causing pain at rest. I70.728 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. I70.728 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. I70.728 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. I70.728 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does I70.728 map to under V28?

I70.728 maps to CMS-HCC V28 HCC 264 (Vascular Disease with Complications). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

2026 ICD-10-CM I70.728: Atherosclerosis of other

I70.728 maps to CMS-HCC V28 264. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · free HCC coding tools

ICD-10-CM Code View

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Code lookupI70.728Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the circulatory system (I00-I99) / Diseases of arteries, arterioles and capillaries (I70-I79)

I70.728

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, other extremity

Hardening and narrowing of a bypass graft in an extremity other than the legs (such as arm) causing pain at rest.

Buddy Insight

CMS-HCC V28

Mapped

HCC 264

Vascular Disease with Complic...

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

I70.7Atherosclerosis of other type of bypass graft(s) of the extremities

I70.72Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain

I70.728Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, other extremity

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for I70.728 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for I70.728 in this effective period.

Related Child Codes

Official

I70.721Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, right leg

I70.722Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, left leg

I70.723Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, bilateral legs

I70.729Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, unspecified extremity

Includes

Official

any condition classifiable to I70.71-
chronic limb-threatening ischemia NOS of other type of bypass graft(s) of the extremities
chronic limb-threatening ischemia of other type of bypass graft(s) of the extremities with rest pain
critical limb ischemia NOS of other type of bypass graft(s) of the extremities
critical limb ischemia of other type of bypass graft(s) of the extremities with rest pain

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for I70.728 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for I70.728 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for I70.728 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for I70.728 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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: other extremity

Type of bypass graft documented (e.g., synthetic, composite, or other non-vein/non-biological graft)

MEAT Support

HCC Buddy guidance

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: other extremity

Type of bypass graft documented (e.g., synthetic, composite, or other non-vein/non-biological graft)

Audit Caution

HCC Buddy guidance

Selecting wrong graft type — 'other type' bypass grafts are specifically for synthetic (e.g., PTFE, Dacron) or composite grafts; autologous vein and nonautologous biological grafts have separate code ranges

Coding rest pain when documentation only describes intermittent claudication (exertional pain) — rest pain is a distinct, more severe clinical finding

Failing to assign additional codes for ulceration or gangrene if also present — rest pain codes include only the rest pain manifestation

Common Mistakes

HCC Buddy guidance

I70.711/I70.712/I70.719 — Atherosclerosis of autologous vein bypass graft with rest pain (different graft type — autologous vein vs. other type)

I70.621/I70.622/I70.629 — Atherosclerosis of nonautologous biological bypass graft with rest pain (different graft type — nonautologous biological vs. other type)

I70.311/I70.312/I70.319 — Atherosclerosis of unspecified type bypass graft with rest pain (less specific graft designation)

I70.211/I70.212/I70.219 — Atherosclerosis of native arteries of extremities with rest pain (native artery, not a bypass graft)

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is I70.728 an HCC code?

Yes. I70.728 (Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, other extremity) maps to HCC 264, Vascular Disease with Complications under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.455. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: I70.728 is billable and maps to V28 HCC 264, Vascular Disease with Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: I70.728
Description: Atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, other extremity
HCC (V28): HCC 264 — Vascular Disease with Complications
RAF reference coefficient: 0.455
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 264, Vascular Disease with Complications

0.455

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 I70.728 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for I70.728

For I70.728 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed I70.728 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

I70.728 is the ICD-10-CM diagnosis code for atherosclerosis of other type of bypass graft(s) of the extremities with rest pain, other extremity. Hardening and narrowing of a bypass graft in an extremity other than the legs (such as arm) causing pain at rest. I70.728 sits in the ICD-10-CM chapter for diseases of the circulatory system (i00-i99), within the section covering diseases of arteries, arterioles and capillaries (i70-i79).

Under the CMS-HCC V28 risk adjustment model, I70.728 maps to Vascular Disease with Complications (HCC 264) with a source-labeled community, non-dual, aged reference coefficient of 0.455. No V24 mapping is shown for I70.728; use the applicable model and payment year when reviewing the V28 mapping. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Document which extremity is affected when the location is not a standard leg location. Because I70.728 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for I70.728 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document which extremity is affected when the location is not a standard leg location
•Verify this code is used only when the affected extremity is not the right leg, left leg, or bilateral legs

Clinical Significance

Atherosclerosis of other type bypass grafts with rest pain (other extremity) 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: other extremity
✓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

•I70.711/I70.712/I70.719: Atherosclerosis of autologous vein bypass graft with rest pain (different graft type: autologous vein vs. other type)
•I70.621/I70.622/I70.629: Atherosclerosis of nonautologous biological bypass graft with rest pain (different graft type: nonautologous biological vs. other type)
•I70.311/I70.312/I70.319: Atherosclerosis of unspecified type bypass graft with rest pain (less specific graft designation)
•I70.211/I70.212/I70.219: Atherosclerosis of native arteries of extremities with rest pain (native artery, not a bypass graft)
•I70.791/I70.792/I70.799: Other atherosclerosis of other type bypass graft without rest pain or ulceration specification