What is ICD-10 code I74.5?

I74.5 is the ICD-10-CM diagnosis code for Embolism and thrombosis of iliac artery. It belongs to the ICD-10-CM chapter for diseases of the circulatory system (i00-i99). I74.5 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. I74.5 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. I74.5 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. I74.5 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does I74.5 map to under V28?

I74.5 maps to CMS-HCC V28 264 (Vascular Disease with Complications). The category number and label come from the CMS-HCC V28 model file for payment year 2026.

What does I74.5 pay in RAF?

I74.5 carries a community, non-dual, aged (CNA) RAF weight of 0.455 under CMS-HCC V28 for payment year 2026. The weight comes from the CMS V28 relative-factor file, not a hand-typed table.

What is the V28 vs V24 difference for I74.5?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For I74.5, V28 maps to Vascular Disease with Complications at RAF 0.455 while V24 mapped to Vascular Disease with Complications at RAF 0.383. Both models can still appear in legacy data and in payer-specific lookback periods.

What documentation supports I74.5?

Verify whether the clot is an embolism (traveled from elsewhere) or thrombosis (formed in place) as this distinction may affect treatment and documentation Check for laterality specification - determine if the blockage is in the right iliac artery, left iliac artery, or bilateral, and code accordingly with appropriate 7th character if required Because I74.5 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score. See the MEAT criteria checklist at /meat-criteria for what Monitor, Evaluate, Assess, or Treat looks like in a note. MEAT is generic documentation evidence, not a payer-specific rule.

2026 ICD-10-CM I74.5: Embolism and thrombosis

I74.5 maps to CMS-HCC V28 264 (RAF 0.455). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC Buddy coding tools

ICD-10-CM Code View

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Code lookupI74.5Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the circulatory system (I00-I99) / Diseases of arteries, arterioles and capillaries (I70-I79)

I74.5

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Embolism and thrombosis of iliac artery

A blood clot (either formed in place or traveled from elsewhere) that blocks blood flow in the iliac artery, which is a major blood vessel in the pelvis that supplies the legs and lower body. This condition can cause pain, numbness, or tissue damage if blood flow is severely restricted.

Buddy Insight

Embolism and thrombosis of the iliac artery is a serious vascular event that can compromise blood flow to the lower extremity, pelvis, and pelvic organs.

CMS-HCC V28

Mapped

HCC 264

Vascular Disease with Complic...

RAF 0.455

CMS-HCC V24

Mapped

HCC 107

Vascular Disease with Complic...

RAF 0.383

ACA/HHS

Mapped

HCC 154

HHS-HCC 154

Varies by metal level

ESRD/PACE

Mapped

HCC 107

Vascular Disease with Complic...

RAF 0.144

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

I74Arterial embolism and thrombosis

I74.5Embolism and thrombosis of iliac artery

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for I74.5 in this effective period.

Excludes 2

Official

atheroembolism (I75.-)
basilar embolism and thrombosis (I63.0-I63.2, I65.1)
carotid embolism and thrombosis (I63.0-I63.2, I65.2)
cerebral embolism and thrombosis (I63.3-I63.5, I66.-)
coronary embolism and thrombosis (I21-I25)

Related Child Codes

Official

I74.0Embolism and thrombosis of abdominal aorta

I74.1Embolism and thrombosis of other and unspecified parts of aorta

I74.2Embolism and thrombosis of arteries of the upper extremities

I74.3Embolism and thrombosis of arteries of the lower extremities

I74.4Embolism and thrombosis of arteries of extremities, unspecified

Includes

Official

embolic infarction
embolic occlusion
thrombotic infarction
thrombotic occlusion

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for I74.5 in this effective period.

Code First

Official

embolism and thrombosis complicating abortion or ectopic or molar pregnancy (O00-O07, O08.2)
embolism and thrombosis complicating pregnancy, childbirth and the puerperium (O88.-)

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for I74.5 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for I74.5 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documentation of embolism or thrombosis specifically in the iliac artery

Specification of common, internal, or external iliac when documented

Laterality (right, left, or bilateral)

Imaging confirmation (CT angiography, angiography)

MEAT Support

HCC Buddy guidance

Documentation of embolism or thrombosis specifically in the iliac artery

Specification of common, internal, or external iliac when documented

Laterality (right, left, or bilateral)

Imaging confirmation (CT angiography, angiography)

Audit Caution

HCC Buddy guidance

Coding as lower extremity arterial embolism when the occlusion is specifically in the iliac artery

Confusing iliac artery thrombosis with iliac vein thrombosis — different vascular systems and code categories

Not distinguishing between acute embolic occlusion and chronic iliac artery occlusion from atherosclerosis

Failing to code bilateral iliac involvement when documented — a saddle embolus may extend into both iliac arteries

Common Mistakes

HCC Buddy guidance

I74.3 — Embolism and thrombosis of arteries of the lower extremities: more distal arterial territory

I74.09 — Other arterial embolism and thrombosis of abdominal aorta: aortic rather than iliac

I72.3 — Aneurysm of iliac artery: aneurysm, not thromboembolism

I74.01 — Saddle embolus of abdominal aorta: specifically at aortic bifurcation, may extend to iliac

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is I74.5 an HCC code?

Yes. I74.5 (Embolism and thrombosis of iliac artery) maps to Vascular Disease with Complications under the CMS-HCC V28 risk adjustment model (and Vascular Disease with Complications under V24), with a community non-dual aged RAF of 0.455. It is billable for payment year 2026.

Coder answer: I74.5 is billable and maps to V28 HCC 264, Vascular Disease with Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: I74.5
Description: Embolism and thrombosis of iliac artery
HCC (V28): HCC 264 — Vascular Disease with Complications
RAF: 0.455
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 264, Vascular Disease with Complications

0.455

V24HCC 107, Vascular Disease with Complications

0.383

ESRDHCC 107, Vascular Disease with Complications

0.144

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. 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.

Work I74.5 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for I74.5

For I74.5 to 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 I74.5 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

I74.5 is the ICD-10-CM diagnosis code for embolism and thrombosis of iliac artery. A blood clot (either formed in place or traveled from elsewhere) that blocks blood flow in the iliac artery, which is a major blood vessel in the pelvis that supplies the legs and lower body. This condition can cause pain, numbness, or tissue damage if blood flow is severely restricted. I74.5 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, I74.5 maps to Vascular Disease with Complications (HCC 264) with a community, non-dual, aged base RAF weight of 0.455. Under the older V24 model, I74.5 mapped to the same category but with a base RAF weight of 0.383, 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 whether the clot is an embolism (traveled from elsewhere) or thrombosis (formed in place) as this distinction may affect treatment and documentation. Because I74.5 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 I74.5 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Verify whether the clot is an embolism (traveled from elsewhere) or thrombosis (formed in place) as this distinction may affect treatment and documentation
•Check for laterality specification - determine if the blockage is in the right iliac artery, left iliac artery, or bilateral, and code accordingly with appropriate 7th character if required

Clinical Significance

Embolism and thrombosis of the iliac artery is a serious vascular event that can compromise blood flow to the lower extremity, pelvis, and pelvic organs. The iliac artery's large caliber means significant embolic burden is required for occlusion, and this event often presents with severe acute ischemia of the affected limb. Accurate coding captures this high-acuity vascular complication.

Documentation Requirements

✓Documentation of embolism or thrombosis specifically in the iliac artery
✓Specification of common, internal, or external iliac when documented
✓Laterality (right, left, or bilateral)
✓Imaging confirmation (CT angiography, angiography)
✓Clinical presentation and degree of limb ischemia
✓Treatment documentation (thrombectomy, thrombolysis, bypass surgery)

Commonly Confused Codes

•I74.3: Embolism and thrombosis of arteries of the lower extremities: more distal arterial territory
•I74.09: Other arterial embolism and thrombosis of abdominal aorta: aortic rather than iliac
•I72.3: Aneurysm of iliac artery: aneurysm, not thromboembolism
•I74.01: Saddle embolus of abdominal aorta: specifically at aortic bifurcation, may extend to iliac