What is ICD-10 code I82.221?

I82.221 is the ICD-10-CM diagnosis code for Chronic embolism and thrombosis of inferior vena cava. A long-standing blood clot in the inferior vena cava that has persisted over time, restricting blood flow from the lower body. I82.221 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. I82.221 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. I82.221 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. I82.221 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 I82.221?

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 I82.221, 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 I82.221?

Ensure documentation clearly indicates chronic status rather than acute presentation Note any complications such as post-thrombotic syndrome or collateral vein development Because I82.221 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 I82.221: Chronic embolism

ICD-10-CM Code View

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Code lookupI82.221Effective 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)

I82.221

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

Chronic embolism and thrombosis of inferior vena cava

A long-standing blood clot in the inferior vena cava that has persisted over time, restricting blood flow from the lower body.

Buddy Insight

Chronic inferior vena cava thrombosis indicates a long-standing, organized clot in the body's largest vein, often requiring IVC filter placement or long-term anticoagulation.

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

I82.2Embolism and thrombosis of vena cava and other thoracic veins

I82.22Embolism and thrombosis of inferior vena cava

I82.221Chronic embolism and thrombosis of inferior vena cava

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for I82.221 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for I82.221 in this effective period.

Related Child Codes

Official

I82.220Acute embolism and thrombosis of inferior vena cava

Includes

Official

ICD-10-CM does not list Includes notes for I82.221 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for I82.221 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for I82.221 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for I82.221 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for I82.221 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Clinical diagnosis of venous thrombosis or thrombophlebitis clearly documented by the treating provider

Diagnostic confirmation via duplex ultrasonography, CT venography, MR venography, or venography with imaging findings described

Current treatment plan including anticoagulation regimen with specific medication, dose, and duration

Documentation of chronic or long-standing nature of the thrombosis, including original date of diagnosis if available

MEAT Support

HCC Buddy guidance

Clinical diagnosis of venous thrombosis or thrombophlebitis clearly documented by the treating provider

Diagnostic confirmation via duplex ultrasonography, CT venography, MR venography, or venography with imaging findings described

Current treatment plan including anticoagulation regimen with specific medication, dose, and duration

Documentation of chronic or long-standing nature of the thrombosis, including original date of diagnosis if available

Audit Caution

HCC Buddy guidance

Assigning a chronic code when the thrombosis is actually a new acute event; always verify the provider's documentation of chronicity

Failing to assign a separate code for pulmonary embolism (I26.-) when documented as a complication of the deep vein thrombosis

Not coding current anticoagulant therapy status (Z79.01) or history of venous thromboembolism (Z86.718) as additional diagnoses when applicable

Common Mistakes

HCC Buddy guidance

I82.210/I82.211 — Superior vena cava thrombosis; involves the SVC returning blood from the upper body, not the IVC

I82.3 — Renal vein thrombosis; clot may extend to IVC but specific renal vein involvement should be coded separately

I82.421-I82.429 — Iliac vein thrombosis; involves pelvic veins that drain into the IVC

I26.- — Pulmonary embolism; may result from IVC thrombus but is a separate diagnosis

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 I82.221 an HCC code?

Yes. I82.221 (Chronic embolism and thrombosis of inferior vena cava) 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: I82.221 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: I82.221
Description: Chronic embolism and thrombosis of inferior vena cava
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 I82.221 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for I82.221

For I82.221 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 I82.221 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

I82.221 is the ICD-10-CM diagnosis code for chronic embolism and thrombosis of inferior vena cava. A long-standing blood clot in the inferior vena cava that has persisted over time, restricting blood flow from the lower body. I82.221 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, I82.221 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, I82.221 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.

Ensure documentation clearly indicates chronic status rather than acute presentation. Because I82.221 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 I82.221 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Ensure documentation clearly indicates chronic status rather than acute presentation
•Note any complications such as post-thrombotic syndrome or collateral vein development

Clinical Significance

Chronic inferior vena cava thrombosis indicates a long-standing, organized clot in the body's largest vein, often requiring IVC filter placement or long-term anticoagulation. Patients typically develop extensive collateral circulation and remain at risk for post-thrombotic syndrome and recurrent venous thromboembolism. This diagnosis reflects ongoing high resource utilization and medical complexity important for risk adjustment.

Documentation Requirements

✓Clinical diagnosis of venous thrombosis or thrombophlebitis clearly documented by the treating provider
✓Diagnostic confirmation via duplex ultrasonography, CT venography, MR venography, or venography with imaging findings described
✓Current treatment plan including anticoagulation regimen with specific medication, dose, and duration
✓Documentation of chronic or long-standing nature of the thrombosis, including original date of diagnosis if available
✓Documentation of any associated central venous devices, malignancy, or precipitating factors
✓Documentation of bilateral lower extremity involvement and any renal function impact

Commonly Confused Codes

•I82.210/I82.211: Superior vena cava thrombosis; involves the SVC returning blood from the upper body, not the IVC
•I82.3: Renal vein thrombosis; clot may extend to IVC but specific renal vein involvement should be coded separately
•I82.421-I82.429: Iliac vein thrombosis; involves pelvic veins that drain into the IVC
•I26.-: Pulmonary embolism; may result from IVC thrombus but is a separate diagnosis
•I82.220: Acute IVC thrombosis; verify acute vs. chronic timeline