What is ICD-10 code I87.019?

I87.019 is the ICD-10-CM diagnosis code for Postthrombotic syndrome with ulcer of unspecified lower extremity. A condition that develops after a blood clot in the leg, causing an open sore or ulcer on the lower leg when the specific side is not documented or specified. I87.019 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. I87.019 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. I87.019 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. I87.019 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 I87.019 map to under V28?

I87.019 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 I87.019: Postthrombotic syndrome

I87.019 maps to CMS-HCC V28 383. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · HCC Buddy coding tools

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 lookupI87.019Effective 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)

I87.019

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

Postthrombotic syndrome with ulcer of unspecified lower extremity

A condition that develops after a blood clot in the leg, causing an open sore or ulcer on the lower leg when the specific side is not documented or specified.

Buddy Insight

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

Mapped

HCC 217

HHS-HCC 217 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 107

Vascular Disease with Complic...

Code-level coefficient reference

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

I87.0Postthrombotic syndrome

I87.01Postthrombotic syndrome with ulcer

I87.019Postthrombotic syndrome with ulcer of unspecified lower extremity

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for I87.019 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for I87.019 in this effective period.

Related Child Codes

Official

I87.011Postthrombotic syndrome with ulcer of right lower extremity

I87.012Postthrombotic syndrome with ulcer of left lower extremity

I87.013Postthrombotic syndrome with ulcer of bilateral lower extremity

Includes

Official

ICD-10-CM does not list Includes notes for I87.019 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for I87.019 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for I87.019 in this effective period.

Use Additional

Official

code to specify site and severity of ulcer (L97.-)

Code Also

Official

ICD-10-CM does not list Code Also instructions for I87.019 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

History of deep vein thrombosis documented or referenced

Diagnosis of postthrombotic syndrome explicitly stated (not just chronic venous insufficiency)

Laterality documented (unspecified lower extremity)

Ulcer presence and characteristics described (size, location, depth, drainage)

MEAT Support

HCC Buddy guidance

History of deep vein thrombosis documented or referenced

Diagnosis of postthrombotic syndrome explicitly stated (not just chronic venous insufficiency)

Laterality documented (unspecified lower extremity)

Ulcer presence and characteristics described (size, location, depth, drainage)

Audit Caution

HCC Buddy guidance

Coding postthrombotic syndrome without documented history of deep vein thrombosis — the diagnosis requires a prior thrombotic event

Using chronic venous insufficiency codes instead of postthrombotic syndrome when the etiology is clearly post-deep vein thrombosis

Failing to specify laterality when it is documented in the medical record, defaulting to unspecified

Not coding the ulcer and inflammation combination (I87.03x) when both components are documented — this captures the full severity

Common Mistakes

HCC Buddy guidance

I87.011/I87.012/I87.013 — Laterality-specific codes preferred when right, left, or bilateral is documented

I87.03x — Postthrombotic syndrome with ulcer AND inflammation; use when both ulcer and inflammation are documented together

I83.2xx — Varicose veins with ulcer and inflammation; ensure the ulcer is attributed to postthrombotic syndrome, not primary varicose veins

I87.31x — Chronic venous hypertension with ulcer; postthrombotic syndrome has a specific prior deep vein thrombosis etiology that distinguishes it from idiopathic venous hypertension

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 I87.019 an HCC code?

Yes. I87.019 (Postthrombotic syndrome with ulcer of unspecified lower extremity) 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: I87.019 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: I87.019
Description: Postthrombotic syndrome with ulcer of unspecified lower extremity
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

ESRDHCC 107, Vascular Disease with Complications

Not separately weighted

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 I87.019 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for I87.019

For I87.019 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 I87.019 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

I87.019 is the ICD-10-CM diagnosis code for postthrombotic syndrome with ulcer of unspecified lower extremity. A condition that develops after a blood clot in the leg, causing an open sore or ulcer on the lower leg when the specific side is not documented or specified. I87.019 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, I87.019 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 I87.019; 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.

Use only when laterality cannot be determined from documentation. Because I87.019 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 I87.019 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Use only when laterality cannot be determined from documentation
•Query provider if possible to determine right, left, or bilateral involvement for more specific coding

Clinical Significance

Postthrombotic syndrome with ulcer of the unspecified lower extremity represents a chronic sequela of deep vein thrombosis where permanent venous valve damage leads to chronic venous hypertension, causing skin breakdown and ulceration. This condition requires ongoing wound care, compression therapy, and close vascular monitoring, significantly increasing healthcare utilization. The presence of ulceration marks advanced disease that substantially impacts the patient's functional status and quality of life.

Documentation Requirements

✓History of deep vein thrombosis documented or referenced
✓Diagnosis of postthrombotic syndrome explicitly stated (not just chronic venous insufficiency)
✓Laterality documented (unspecified lower extremity)
✓Ulcer presence and characteristics described (size, location, depth, drainage)
✓Signs of chronic venous changes (hyperpigmentation, lipodermatosclerosis, edema)
✓Current wound management and compression therapy plan
✓Assessment of venous reflux or obstruction if available

Commonly Confused Codes

•I87.011/I87.012/I87.013: Laterality-specific codes preferred when right, left, or bilateral is documented
•I87.03x: Postthrombotic syndrome with ulcer AND inflammation; use when both ulcer and inflammation are documented together
•I83.2xx: Varicose veins with ulcer and inflammation; ensure the ulcer is attributed to postthrombotic syndrome, not primary varicose veins
•I87.31x: Chronic venous hypertension with ulcer; postthrombotic syndrome has a specific prior deep vein thrombosis etiology that distinguishes it from idiopathic venous hypertension
•L97.xxx: Non-pressure chronic ulcer of lower limb; use only when the ulcer is not attributable to postthrombotic syndrome or venous disease