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I75.019 ICD-10-CM Code: Atheroembolism of unspecified upper extremity

I75.019 maps to CMS-HCC V28 264 (RAF 0.455). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC Buddy coding tools

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

I75.019

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

Atheroembolism of unspecified upper extremity

Cholesterol crystals or plaque fragments break loose from arteries and lodge in blood vessels of an arm, but the specific arm is not documented.

Buddy the Bee presenting code insight

Buddy Insight

Atheroembolism of unspecified upper extremity captures cholesterol embolization to the upper limb when laterality has not been documented.

CMS-HCC V28

HCC 264

RAF 0.455

CMS-HCC V24

HCC 107

RAF 0.383

ACA/HHS

HCC 154

Varies by metal level

ESRD/PACE

HCC 107

RAF 0.144

RXHCC

N/A

—

Not mapped

Code Book Path

Official
I75.0Atheroembolism of extremities
I75.01Atheroembolism of upper extremity
I75.019Atheroembolism of unspecified upper extremity

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for I75.019 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for I75.019 in this effective period.

Related Child Codes

Official
I75.011Atheroembolism of right upper extremity
I75.012Atheroembolism of left upper extremity
I75.013Atheroembolism of bilateral upper extremities

Includes

Official

ICD-10-CM does not list Includes notes for I75.019 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for I75.019 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for I75.019 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for I75.019 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for I75.019 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Documentation of atheroembolism affecting an upper extremity
Query provider for laterality specification
Clinical findings of cholesterol embolization
Source identification when possible

MEAT Support

HCC Buddy guidance
Documentation of atheroembolism affecting an upper extremity
Query provider for laterality specification
Clinical findings of cholesterol embolization
Source identification when possible

Audit Caution

HCC Buddy guidance
Using this unspecified code when physical examination or imaging clearly identifies the affected side
Not querying the provider for laterality documentation
Confusing atheroembolism with standard arterial thromboembolism — different pathophysiology and codes
Missing the opportunity to capture laterality from nursing notes, imaging reports, or procedure documentation

Common Mistakes

HCC Buddy guidance
I75.011 — Atheroembolism of right upper extremity: use when right side is documented
I75.012 — Atheroembolism of left upper extremity: use when left side is documented
I75.013 — Atheroembolism of bilateral upper extremities: use when both sides are documented
I74.2 — Embolism and thrombosis of arteries of the upper extremities: general arterial embolism, not specifically atheroembolism

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 I75.019 an HCC code?

Yes. I75.019 (Atheroembolism of unspecified upper extremity) 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: I75.019 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
I75.019
Description
Atheroembolism of unspecified upper extremity
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 I75.019 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for I75.019

For I75.019 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 I75.019 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

I75.019 is the ICD-10-CM diagnosis code for atheroembolism of unspecified upper extremity. Cholesterol crystals or plaque fragments break loose from arteries and lodge in blood vessels of an arm, but the specific arm is not documented. I75.019 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, I75.019 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, I75.019 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.

Use only when laterality cannot be determined from medical record. Because I75.019 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 I75.019 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Use only when laterality cannot be determined from medical record
  • •Query provider if documentation is ambiguous to obtain more specific code

Clinical Significance

Atheroembolism of unspecified upper extremity captures cholesterol embolization to the upper limb when laterality has not been documented. While this still qualifies for the vascular complication HCC category, the unspecified laterality represents incomplete documentation. Atheroembolism reflects severe underlying atherosclerotic disease requiring comprehensive vascular management.

Documentation Requirements

  • ✓Documentation of atheroembolism affecting an upper extremity
  • ✓Query provider for laterality specification
  • ✓Clinical findings of cholesterol embolization
  • ✓Source identification when possible
  • ✓Systemic assessment for multi-organ involvement
  • ✓Treatment documentation

Commonly Confused Codes

  • •I75.011: Atheroembolism of right upper extremity: use when right side is documented
  • •I75.012: Atheroembolism of left upper extremity: use when left side is documented
  • •I75.013: Atheroembolism of bilateral upper extremities: use when both sides are documented
  • •I74.2: Embolism and thrombosis of arteries of the upper extremities: general arterial embolism, not specifically atheroembolism

Child Codes

I75.011Atheroembolism of right upper extremity
HCC 264
I75.012Atheroembolism of left upper extremity
HCC 264
I75.013Atheroembolism of bilateral upper extremities
HCC 264
I75.019Atheroembolism of unspecified upper extremity
HCC 264

Code Hierarchy

└I75Atheroembolism└I75.0Atheroembolism of extremities└I75.01Atheroembolism of upper extremity└I75.019Atheroembolism of unspecified upper extremity
└I75.019Atheroembolism of unspecified upper extremity

Because I75.019 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.

I75.019 maps to CMS-HCC V28 category 264, Vascular Disease with Complications. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. Because I75.019 carries a payment HCC, you can see what it adds to a RAF score and check the documentation the chart needs before it is submitted.

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Open I75.019 in the Code Book for the full Index-to-Tabular path, MEAT checklist, and V28 HCC mapping, or in the Encoder to code from a keyword search. Pro includes 7 days to try everything, no card required.

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