I74.4
BillableEmbolism and thrombosis of arteries of extremities, unspecified
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is I74.4 an HCC code?
Yes. I74.4 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 I74.4
For I74.4to 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 I74.4 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
I74.4 is the ICD-10-CM diagnosis code for embolism and thrombosis of arteries of extremities, unspecified. A blood clot in the arteries of the arms or legs when the specific location cannot be determined or is not documented. I74.4 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, I74.4 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, I74.4 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.
Use this code only when documentation does not specify whether the clot is in upper or lower extremities. Because I74.4 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 I74.4 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when documentation does not specify whether the clot is in upper or lower extremities
- •Query the provider for clarification on location to allow for more specific coding when possible
Clinical Significance
Embolism and thrombosis of arteries of extremities, unspecified, captures acute arterial occlusion when the specific extremity is not documented. While this still qualifies for the higher-weighted vascular disease complication category, the lack of specificity should prompt a review of clinical documentation to determine whether upper or lower extremity is involved.
Documentation Requirements
- ✓Documentation of arterial embolism or thrombosis in an extremity
- ✓Attempt to clarify which extremity is affected from clinical context
- ✓Clinical presentation of acute limb ischemia
- ✓Source evaluation
- ✓Treatment documentation
- ✓Query provider for extremity specification when possible
Commonly Confused Codes
- •I74.2 — Embolism and thrombosis of arteries of the upper extremities: use when upper extremity is specified
- •I74.3 — Embolism and thrombosis of arteries of the lower extremities: use when lower extremity is specified
- •I74.9 — Embolism and thrombosis of unspecified artery: even less specific — at least I74.4 identifies an extremity
- •I82.4xx — Acute embolism and thrombosis of deep veins of lower extremity: venous, not arterial