I76 ICD-10-CM Code: Septic arterial embolism
I76 maps to CMS-HCC V28 264. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. 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)
I76
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceSeptic 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.
Buddy Insight
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.
CMS-HCC V28
MappedHCC 264
Coefficient HCC 264: 0.455 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 154
Code-level coefficient reference
ESRD/PACE
MappedHCC 107
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for I76. Check the code and parent instructions in the Code Book.
Excludes 2
Official- septic pulmonary embolism (I26.01, I26.90)
- certain conditions originating in the perinatal period (P04-P96)Inherited from I00-I99
- certain infectious and parasitic diseases (A00-B99)Inherited from I00-I99
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from I00-I99
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from I00-I99
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from I00-I99
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from I00-I99
- neoplasms (C00-D49)Inherited from I00-I99
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from I00-I99
- systemic connective tissue disorders (M30-M36)Inherited from I00-I99
- transient cerebral ischemic attacks and related syndromes (G45.-)Inherited from I00-I99
Related Codes
No related codes are included in this display for I76. Check the Code Book for the complete code path.
Includes
OfficialNo Includes notes are included in this display for I76. Check the code and parent instructions in the Code Book.
Excludes 1
OfficialNo Excludes 1 notes are included in this display for I76. Check the code and parent instructions in the Code Book.
Code First
Official- underlying infection, such as:
- infective endocarditis (I33.0)
- lung abscess (J85.-)
Use Additional
Official- code to identify the site of the embolism (I74.-)
Code Also
OfficialNo Code Also instructions are included in this display for I76. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 I76 an HCC code?
Yes. I76 (Septic arterial embolism) maps to HCC 264, Vascular Disease with Complications under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.455. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: I76 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
- I76
- Description
- Septic arterial embolism
- HCC (V28)
- HCC 264 — Vascular Disease with Complications
- RAF reference coefficient
- 0.455
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work I76 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for I76
For I76, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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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 source-labeled community, non-dual, aged reference coefficient of 0.455. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Always investigate and document the source of infection and causative organism. For I76, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, 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