I76
BillableSeptic arterial embolism
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is I76 an HCC code?
Yes. I76 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 I76
For I76to 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 I76 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
I76 is the ICD-10-CM diagnosis code for septic arterial embolism. A blood clot containing bacteria or infected material breaks loose and travels through arteries, potentially causing infection and tissue damage at the site where it lodges. I76 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, I76 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, I76 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.
Always investigate and document the source of infection and causative organism. Because I76 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 I76 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Always investigate and document the source of infection and causative organism
- •Coordinate coding with infectious disease documentation and any associated sepsis codes
Clinical Significance
Septic arterial embolism occurs when infected material (typically from infective endocarditis or a vascular graft infection) lodges in an artery, causing both vascular occlusion and infection at the embolic site. This dual pathology creates severe complications including mycotic aneurysm formation, abscess development, and end-organ damage. This code captures a life-threatening complication requiring aggressive treatment.
Documentation Requirements
- ✓Documentation of septic (infected) arterial embolism
- ✓Source of infection (infective endocarditis, infected vascular graft, other intravascular infection)
- ✓Affected artery and target organ
- ✓Microbiological data (blood cultures, tissue cultures)
- ✓Imaging findings confirming embolic events
- ✓Treatment plan (antibiotics, surgical intervention, source control)
Use Additional Code
- code to identify the site of the embolism (I74.-)
Commonly Confused Codes
- •I74.x — Arterial embolism and thrombosis: non-septic arterial embolism without infectious component
- •I33.0 — Acute and subacute infective endocarditis: the source of septic emboli, not the embolism itself
- •A41.x — Other sepsis: systemic infection without specific arterial embolism
- •I72.x — Aneurysm of artery: mycotic aneurysm from septic embolism requires separate coding