I74.5
BillableEmbolism and thrombosis of iliac artery
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is I74.5 an HCC code?
Yes. I74.5 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 I74.5
For I74.5to 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.
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 0.356. Under the older V24 model, I74.5 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 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