I74.09
BillableOther arterial embolism and thrombosis of abdominal aorta
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is I74.09 an HCC code?
Yes. I74.09 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 I74.09
For I74.09to 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 I74.09 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
I74.09 is the ICD-10-CM diagnosis code for other arterial embolism and thrombosis of abdominal aorta. A blood clot or blockage in the abdominal aorta (the main blood vessel in the belly) that is not specified as a saddle embolus. This condition restricts blood flow to the abdomen and lower body and requires urgent medical attention. I74.09 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, I74.09 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, I74.09 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.
Verify the specific type of embolism or thrombosis in the documentation; if it's a saddle embolus, use I74.01 instead. Because I74.09 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 I74.09 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify the specific type of embolism or thrombosis in the documentation; if it's a saddle embolus, use I74.01 instead
- •Ensure the location is confirmed as the abdominal aorta and not the thoracic or thoracoabdominal aorta, which have different codes
Clinical Significance
Other arterial embolism and thrombosis of the abdominal aorta includes non-saddle type embolic or thrombotic events in the abdominal aorta. These represent serious vascular complications that can cause mesenteric ischemia, renal ischemia, or lower extremity compromise depending on the level of occlusion. Accurate coding reflects the acute vascular complication burden.
Documentation Requirements
- ✓Documentation of arterial embolism or thrombosis in the abdominal aorta
- ✓Imaging confirmation of the location and extent of the occlusion
- ✓Clinical presentation and affected vascular territories
- ✓Source of embolism when identified
- ✓Treatment documentation (anticoagulation, thrombectomy, thrombolysis)
- ✓Assessment of end-organ damage (renal function, bowel viability, limb perfusion)
Commonly Confused Codes
- •I74.01 — Saddle embolus of abdominal aorta: specific to bifurcation saddle type
- •I74.11 — Embolism and thrombosis of thoracic aorta: thoracic location rather than abdominal
- •I74.5 — Embolism and thrombosis of iliac artery: iliac territory, distal to abdominal aorta
- •I71.3 — Abdominal aortic aneurysm, ruptured: aneurysm rupture is different from embolism/thrombosis