What is ICD-10 code I80.223?

I80.223 is the ICD-10-CM diagnosis code for Phlebitis and thrombophlebitis of popliteal vein, bilateral. Inflammation and blood clot formation affecting both popliteal veins (behind both knees). It belongs to the ICD-10-CM chapter for diseases of the circulatory system (i00-i99). I80.223 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. I80.223 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. I80.223 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. I80.223 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.

What is the V28 vs V24 difference for I80.223?

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 I80.223, V28 maps to Deep Vein Thrombosis and Pulmonary Embolism at RAF 0.294 while V24 mapped to Vascular Disease at RAF 0.288. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting I80.223?

Bilateral coding requires documentation confirming involvement of both legs; do not assume bilateral without explicit provider statement This represents a more severe presentation; ensure appropriate clinical correlation with symptoms and imaging findings Because I80.223 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.

2026 ICD-10-CM I80.223: Phlebitis

ICD-10-CM Code View

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Code lookupI80.223Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the circulatory system (I00-I99) / Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified (I80-I89)

I80.223

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

Phlebitis and thrombophlebitis of popliteal vein, bilateral

Inflammation and blood clot formation affecting both popliteal veins (behind both knees).

Buddy Insight

Phlebitis and thrombophlebitis of the bilateral popliteal vein represents deep vein thrombosis at the junction between the proximal and distal deep venous systems.

CMS-HCC V28

Mapped

HCC 267

Deep Vein Thrombosis and Pulm...

RAF 0.294

CMS-HCC V24

Mapped

HCC 108

Vascular Disease

RAF 0.288

ACA/HHS

Mapped

HCC 156

HHS-HCC 156

Varies by metal level

ESRD/PACE

Mapped

HCC 108

Vascular Disease

RAF 0.073

RXHCC

Mapped

HCC 215

Pulmonary Embolism and Other ...

RAF 0.228

Code Book Path

Official

I80.2Phlebitis and thrombophlebitis of other and unspecified deep vessels of lower extremities

I80.22Phlebitis and thrombophlebitis of popliteal vein

I80.223Phlebitis and thrombophlebitis of popliteal vein, bilateral

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for I80.223 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for I80.223 in this effective period.

Related Child Codes

Official

I80.221Phlebitis and thrombophlebitis of right popliteal vein

I80.222Phlebitis and thrombophlebitis of left popliteal vein

I80.229Phlebitis and thrombophlebitis of unspecified popliteal vein

Includes

Official

ICD-10-CM does not list Includes notes for I80.223 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for I80.223 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for I80.223 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for I80.223 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for I80.223 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Duplex ultrasound confirming popliteal vein thrombosis with non-compressibility and/or visible thrombus

Laterality — bilateral popliteal vein documented

Acuity — acute, subacute, or chronic thrombosis

Assessment of clot extent (proximal or distal extension)

MEAT Support

HCC Buddy guidance

Duplex ultrasound confirming popliteal vein thrombosis with non-compressibility and/or visible thrombus

Laterality — bilateral popliteal vein documented

Acuity — acute, subacute, or chronic thrombosis

Assessment of clot extent (proximal or distal extension)

Audit Caution

HCC Buddy guidance

Confusing popliteal vein (deep) with lesser saphenous vein (superficial) in the posterior knee area

Not specifying laterality when the ultrasound clearly identifies the affected side

Failing to differentiate between acute and chronic thrombosis for correct code selection

Not coding concurrent above-knee or below-knee extension of the thrombus

Common Mistakes

HCC Buddy guidance

I80.10-I80.13 — Femoral vein thrombophlebitis: more proximal vein involvement

I80.23x — Tibial vein thrombophlebitis: more distal vein

I87.2 — Venous insufficiency (chronic): late sequela, not acute thrombosis

I80.0x — Superficial vessel thrombophlebitis: superficial, not deep

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 I80.223 an HCC code?

Yes. I80.223 (Phlebitis and thrombophlebitis of popliteal vein, bilateral) maps to Deep Vein Thrombosis and Pulmonary Embolism under the CMS-HCC V28 risk adjustment model (and Vascular Disease under V24), with a community non-dual aged RAF of 0.294. It is billable for payment year 2026.

Coder answer: I80.223 is billable and maps to V28 HCC 267, Deep Vein Thrombosis and Pulmonary Embolism. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: I80.223
Description: Phlebitis and thrombophlebitis of popliteal vein, bilateral
HCC (V28): HCC 267 — Deep Vein Thrombosis and Pulmonary Embolism
RAF: 0.294
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 267, Deep Vein Thrombosis and Pulmonary Embolism

0.294

V24HCC 108, Vascular Disease

0.288

ESRDHCC 108, Vascular Disease

0.073

RxHCCHCC 215, Pulmonary Embolism and Other Vascular Disease

0.228

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 I80.223 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for I80.223

For I80.223 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 I80.223 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

I80.223 is the ICD-10-CM diagnosis code for phlebitis and thrombophlebitis of popliteal vein, bilateral. Inflammation and blood clot formation affecting both popliteal veins (behind both knees). I80.223 sits in the ICD-10-CM chapter for diseases of the circulatory system (i00-i99), within the section covering diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified (i80-i89).

Under the CMS-HCC V28 risk adjustment model, I80.223 maps to Deep Vein Thrombosis and Pulmonary Embolism (HCC 267) with a community, non-dual, aged base RAF weight of 0.294. Under the older CMS-HCC V24 model, I80.223 maps to Vascular Disease (HCC 108) with a community, non-dual, aged base RAF weight of 0.288. 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.

Bilateral coding requires documentation confirming involvement of both legs; do not assume bilateral without explicit provider statement. Because I80.223 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 I80.223 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Bilateral coding requires documentation confirming involvement of both legs; do not assume bilateral without explicit provider statement
•This represents a more severe presentation; ensure appropriate clinical correlation with symptoms and imaging findings

Clinical Significance

Phlebitis and thrombophlebitis of the bilateral popliteal vein represents deep vein thrombosis at the junction between the proximal and distal deep venous systems. The popliteal vein is generally considered a proximal vein, and thrombosis here carries meaningful risk of pulmonary embolism. It commonly occurs in the setting of immobility, surgery, or underlying hypercoagulable states, requiring anticoagulation therapy.

Documentation Requirements

✓Duplex ultrasound confirming popliteal vein thrombosis with non-compressibility and/or visible thrombus
✓Laterality — bilateral popliteal vein documented
✓Acuity — acute, subacute, or chronic thrombosis
✓Assessment of clot extent (proximal or distal extension)
✓Evaluation for pulmonary embolism symptoms
✓Anticoagulation plan with specific agent and planned duration
✓Risk factor documentation and assessment