I74.3
BillableEmbolism and thrombosis of arteries of the lower extremities
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is I74.3 an HCC code?
Yes. I74.3 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 I74.3
For I74.3to 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 I74.3 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
I74.3 is the ICD-10-CM diagnosis code for embolism and thrombosis of arteries of the lower extremities. A blood clot in the arteries of the legs that blocks blood flow and can cause severe pain, coldness, or tissue death in the lower extremities. I74.3 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, I74.3 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, I74.3 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 common presentation; always document laterality (right, left, or bilateral) and specific artery affected when possible. Because I74.3 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 I74.3 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a common presentation; always document laterality (right, left, or bilateral) and specific artery affected when possible
- •Often requires additional codes for acute limb ischemia and complications such as gangrene
Clinical Significance
Embolism and thrombosis of arteries of the lower extremities is a common and serious vascular emergency that can lead to acute limb ischemia, tissue necrosis, and potential amputation. Most commonly caused by cardiac embolism or in-situ thrombosis on atherosclerotic plaques, this condition requires urgent intervention. Accurate coding is critical for capturing the acute complication burden.
Documentation Requirements
- ✓Documentation of arterial embolism or thrombosis in the lower extremity
- ✓Affected artery when specified (femoral, popliteal, tibial, peroneal)
- ✓Laterality (right, left, or bilateral)
- ✓Acute limb ischemia classification (Rutherford categories I-III)
- ✓Source of embolism when identified
- ✓Treatment documentation (anticoagulation, thrombectomy, bypass, amputation if applicable)
Commonly Confused Codes
- •I74.2 — Embolism and thrombosis of arteries of the upper extremities: different extremity
- •I74.4 — Embolism and thrombosis of arteries of extremities, unspecified: use I74.3 when lower extremity is specified
- •I74.5 — Embolism and thrombosis of iliac artery: iliac is proximal to the lower extremity arteries
- •I70.2xx — Atherosclerosis of native arteries of extremities: chronic atherosclerotic disease, not acute thromboembolism