I74.11
BillableEmbolism and thrombosis of thoracic aorta
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is I74.11 an HCC code?
Yes. I74.11 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 I74.11
For I74.11to 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 I74.11 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
I74.11 is the ICD-10-CM diagnosis code for embolism and thrombosis of thoracic aorta. A blood clot in the thoracic aorta (the upper portion of the main artery in the chest) that can restrict blood flow to the upper body and vital organs. I74.11 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, I74.11 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, I74.11 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.
Document whether the clot is acute or chronic, as this affects treatment approach. Because I74.11 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 I74.11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document whether the clot is acute or chronic, as this affects treatment approach
- •May be associated with aortic dissection or atherosclerotic disease; code additional conditions separately
Clinical Significance
Embolism and thrombosis of the thoracic aorta is a serious vascular event that can compromise blood flow to the brain via arch vessels, the spinal cord, and upper extremities. This location-specific code reflects the critical nature of thoracic aortic thromboembolism and its potential for devastating neurological and vascular complications.
Documentation Requirements
- ✓Documentation of embolism or thrombosis specifically in the thoracic aorta
- ✓Imaging confirmation (CT angiography, transesophageal echocardiogram)
- ✓Assessment of arch vessel involvement and cerebral perfusion
- ✓Source evaluation (cardiac, proximal atherosclerotic plaque)
- ✓Treatment documentation (anticoagulation, surgical intervention)
- ✓Neurological assessment for spinal cord or cerebral ischemia
Commonly Confused Codes
- •I74.09 — Other arterial embolism and thrombosis of abdominal aorta: abdominal rather than thoracic location
- •I74.10 — Embolism and thrombosis of unspecified parts of aorta: use I74.11 when thoracic location is documented
- •I71.01 — Dissection of thoracic aorta: dissection is a different pathology from thromboembolism
- •I74.19 — Embolism and thrombosis of other parts of aorta: for aortic segments not otherwise specified