What is ICD-10 code I83.204?

I83.204 is the ICD-10-CM diagnosis code for Varicose veins of unspecified lower extremity with both ulcer of heel and midfoot and inflammation. Enlarged veins in an unspecified leg with both an open sore on the heel or midfoot and inflammation present simultaneously. I83.204 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. I83.204 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. I83.204 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. I83.204 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 I83.204?

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 I83.204, V28 maps to Diabetic Skin Ulcer and Severe Skin Conditions at RAF 0.517 while V24 mapped to Vascular Disease with Complications at RAF 0.450. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting I83.204?

Ensure documentation specifies both the ulcer location (heel/midfoot) and the inflammatory component Attempt to determine laterality from clinical documentation to use a more specific code when possible Because I83.204 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.

I83.204 ICD-10 Code: Varicose veins of unspecified

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupI83.204Effective 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)

I83.204

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

Varicose veins of unspecified lower extremity with both ulcer of heel and midfoot and inflammation

Enlarged veins in an unspecified leg with both an open sore on the heel or midfoot and inflammation present simultaneously.

Buddy Insight

Varicose veins with both ulceration and inflammation represent an advanced stage of chronic venous insufficiency with significant wound care needs and infection risk.

CMS-HCC V28

Mapped

HCC 383

Diabetic Skin Ulcer and Sever...

RAF 0.517

CMS-HCC V24

Mapped

HCC 107

Vascular Disease with Complic...

RAF 0.450

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Mapped

HCC 107

Vascular Disease with Complic...

RAF 0.0

RXHCC

Not risk-adjusted for this model/period.

RAF 0

Code Trumping

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Code Book Path

Official

I83.2Varicose veins of lower extremities with both ulcer and inflammation

I83.20Varicose veins of unspecified lower extremity with both ulcer and inflammation

I83.204Varicose veins of unspecified lower extremity with both ulcer of heel and midfoot and inflammation

Inclusion Terms

Official

Varicose veins of unspecified lower extremity with both ulcer of plantar surface of midfoot and inflammation

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for I83.204 in this effective period.

Related Child Codes

Official

I83.201Varicose veins of unspecified lower extremity with both ulcer of thigh and inflammation

I83.202Varicose veins of unspecified lower extremity with both ulcer of calf and inflammation

I83.203Varicose veins of unspecified lower extremity with both ulcer of ankle and inflammation

I83.205Varicose veins of unspecified lower extremity with both ulcer other part of foot and inflammation

I83.208Varicose veins of unspecified lower extremity with both ulcer of other part of lower extremity and inflammation

Includes

Official

ICD-10-CM does not list Includes notes for I83.204 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for I83.204 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for I83.204 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for I83.204 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for I83.204 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Provider documentation of varicose veins with active ulceration of the unspecified lower extremity

Specific ulcer location documented (heel and midfoot) — anatomical site determines code specificity

Description of ulcer characteristics: size, depth, wound bed appearance, drainage, and stage if applicable

Confirmation that the ulcer is a direct complication of the varicose veins (causal relationship)

MEAT Support

HCC Buddy guidance

Provider documentation of varicose veins with active ulceration of the unspecified lower extremity

Specific ulcer location documented (heel and midfoot) — anatomical site determines code specificity

Description of ulcer characteristics: size, depth, wound bed appearance, drainage, and stage if applicable

Confirmation that the ulcer is a direct complication of the varicose veins (causal relationship)

Audit Caution

HCC Buddy guidance

Coding the ulcer location incorrectly — the 6th character specifies the anatomical site (thigh, calf, ankle, heel/midfoot, other foot, other lower leg) and must match documentation exactly

Using an unspecified laterality code when the affected side is documented — always capture the specific side

Forgetting to document or code the inflammatory component — this code requires BOTH ulcer and inflammation to be present and documented

Failing to assign an additional code for ulcer severity/stage when applicable per coding guidelines

Common Mistakes

HCC Buddy guidance

I83.004 — Varicose veins of unspecified lower extremity with ulcer of heel/midfoot WITHOUT inflammation; use when inflammation is not documented

I83.10-I83.12 — Varicose veins with inflammation only (no ulcer); use when there is inflammation but no ulceration

L97.x — Non-pressure chronic ulcer of lower limb; use when the ulcer is NOT caused by varicose veins (different etiology)

I87.2 — Venous insufficiency (chronic/peripheral); use when there is venous insufficiency without varicose veins or ulceration

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is I83.204 an HCC code?

Yes. I83.204 maps to Diabetic Skin Ulcer and Severe Skin Conditions under the CMS-HCC V28 risk adjustment model (and Vascular Disease with Complications under V24).

HCC Category Mapping

V28HCC 383, Diabetic Skin Ulcer and Severe Skin Conditions

0.517

V24HCC 107, Vascular Disease with Complications

0.450

ESRDHCC 107, Vascular Disease with Complications

0.000

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 I83.204

For I83.204to 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 I83.204 during that encounter, not just copy-forwarded from a problem list.

What This Code Means

I83.204 is the ICD-10-CM diagnosis code for varicose veins of unspecified lower extremity with both ulcer of heel and midfoot and inflammation. Enlarged veins in an unspecified leg with both an open sore on the heel or midfoot and inflammation present simultaneously. I83.204 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, I83.204 maps to Diabetic Skin Ulcer and Severe Skin Conditions (HCC 383) with a community, non-dual, aged base RAF weight of 0.517. Under the older CMS-HCC V24 model, I83.204 maps to Vascular Disease with Complications (HCC 107) with a community, non-dual, aged base RAF weight of 0.450. 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 specifies both the ulcer location (heel/midfoot) and the inflammatory component. Because I83.204 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 I83.204 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Ensure documentation specifies both the ulcer location (heel/midfoot) and the inflammatory component
•Attempt to determine laterality from clinical documentation to use a more specific code when possible

Clinical Significance

Varicose veins with both ulceration and inflammation represent an advanced stage of chronic venous insufficiency with significant wound care needs and infection risk. The combination of ulcer and inflammation indicates a more complex clinical picture requiring intensive wound management, compression therapy, and potentially surgical intervention. This maps to a high-value HCC reflecting the substantial healthcare resource utilization these patients require.

Documentation Requirements

✓Provider documentation of varicose veins with active ulceration of the unspecified lower extremity
✓Specific ulcer location documented (heel and midfoot) — anatomical site determines code specificity
✓Description of ulcer characteristics: size, depth, wound bed appearance, drainage, and stage if applicable
✓Confirmation that the ulcer is a direct complication of the varicose veins (causal relationship)
✓Current wound care treatment plan and any changes in management
✓Documentation of inflammatory component (redness, warmth, induration, stasis dermatitis) in addition to the ulcer
✓Consider whether the inflammation represents cellulitis or infection requiring an additional code
✓Query provider for laterality (right vs. left) — unspecified codes should only be used as a last resort

Commonly Confused Codes

•I83.004: Varicose veins of unspecified lower extremity with ulcer of heel/midfoot WITHOUT inflammation; use when inflammation is not documented
•I83.10-I83.12: Varicose veins with inflammation only (no ulcer); use when there is inflammation but no ulceration
•L97.x: Non-pressure chronic ulcer of lower limb; use when the ulcer is NOT caused by varicose veins (different etiology)
•I87.2: Venous insufficiency (chronic/peripheral); use when there is venous insufficiency without varicose veins or ulceration
•L89.x: Pressure ulcer codes; distinguish from venous stasis ulcers which are caused by varicose veins, not prolonged pressure