I74.01
BillableSaddle embolus of abdominal aorta
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is I74.01 an HCC code?
Yes. I74.01 maps to Vascular Disease with Complications under the CMS-HCC V28 risk adjustment model (and Vascular Disease with Complications under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for I74.01
For I74.01to 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 I74.01 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
I74.01 is the ICD-10-CM diagnosis code for saddle embolus of abdominal aorta. A saddle embolus is a blood clot that straddles the bifurcation of the abdominal aorta, blocking blood flow to both legs and potentially causing severe limb-threatening ischemia. I74.01 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, I74.01 maps to Vascular Disease with Complications (HCC 264) with a community, non-dual, aged base RAF weight of 0.356. Under the older V24 model, I74.01 mapped to the same category but with a base RAF weight of 0.450 — V28 recalibrated weights across the entire model. 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.
This is a medical emergency requiring immediate intervention; code as acute presentation. Because I74.01 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. 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, RAF weights, and MEAT documentation criteria for I74.01 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a medical emergency requiring immediate intervention; code as acute presentation
- •Often requires additional codes for acute limb ischemia and may lead to amputation codes if tissue death occurs
Clinical Significance
Saddle embolus of the abdominal aorta is a serious vascular emergency where a large embolus lodges at the aortic bifurcation, blocking blood flow to both lower extremities. This results in acute bilateral lower extremity ischemia and constitutes a surgical emergency. The acuity and severity of this condition warrants its placement in the higher-weighted vascular disease with complications HCC category.
Documentation Requirements
- ✓Documentation of saddle embolus at the aortic bifurcation
- ✓Imaging confirmation (CT angiography or conventional angiography)
- ✓Clinical presentation (acute bilateral lower extremity ischemia, absent femoral pulses)
- ✓Source of embolism when identified (cardiac, proximal arterial)
- ✓Emergency intervention documentation (thrombectomy, thrombolysis)
- ✓Assessment of limb viability and end-organ damage
Commonly Confused Codes
- •I74.09 — Other arterial embolism and thrombosis of abdominal aorta: non-saddle aortic embolism
- •I74.3 — Embolism and thrombosis of arteries of the lower extremities: distal to the aortic bifurcation
- •I26.x — Pulmonary embolism: different vascular territory entirely
- •I74.5 — Embolism and thrombosis of iliac artery: iliac, not aortic bifurcation