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.

Which HCC does I83.204 map to under V28?

I83.204 maps to CMS-HCC V28 HCC 383 (Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

2026 ICD-10-CM I83.204: Varicose veins

I83.204 maps to CMS-HCC V28 383. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · HCC coding software

ICD-10-CM Code View

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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

Chronic Ulcer of Skin, Except...

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

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

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 I83.204 an HCC code?

Yes. I83.204 (Varicose veins of unspecified lower extremity with both ulcer of heel and midfoot and inflammation) maps to HCC 383, Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.646. 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: I83.204 is billable and maps to V28 HCC 383, Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: I83.204
Description: Varicose veins of unspecified lower extremity with both ulcer of heel and midfoot and inflammation
HCC (V28): HCC 383 — Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle
RAF reference coefficient: 0.646
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 383, Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle

0.646

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 I83.204 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for I83.204

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

Coder workflow notes

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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 Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle (HCC 383) with a source-labeled community, non-dual, aged reference coefficient of 0.646. No V24 mapping is shown for I83.204; use the applicable model and payment year when reviewing the V28 mapping. 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. 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.

Ensure documentation specifies both the ulcer location (heel/midfoot) and the inflammatory component. Because I83.204 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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 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