I87.311 ICD-10-CM Code: Chronic venous hypertension (idiopathic) with ulcer of right lower extremity
I87.311 maps to CMS-HCC V28 383. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software
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FY 2026 Apr update / Diseases of the circulatory system (I00-I99) / Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified (I80-I89)
I87.311
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceChronic venous hypertension (idiopathic) with ulcer of right lower extremity
A condition where high pressure builds up in the veins of the right leg due to an unknown cause, resulting in an open sore or ulcer on that leg.
Buddy Insight
Chronic venous hypertension (idiopathic) with ulcer of the right lower extremity indicates sustained elevated venous pressure without an identifiable secondary cause, resulting in skin breakdown and chronic ulceration.
CMS-HCC V28
MappedHCC 383
Coefficient HCC 383: 0.646 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 217
Code-level coefficient reference
ESRD/PACE
MappedHCC 107
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Stasis edemaInherited from I87.3
Excludes 2
Official- certain conditions originating in the perinatal period (P04-P96)Inherited from I00-I99
- certain infectious and parasitic diseases (A00-B99)Inherited from I00-I99
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from I00-I99
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from I00-I99
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from I00-I99
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from I00-I99
- neoplasms (C00-D49)Inherited from I00-I99
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from I00-I99
- systemic connective tissue disorders (M30-M36)Inherited from I00-I99
- transient cerebral ischemic attacks and related syndromes (G45.-)Inherited from I00-I99
Related Codes
Includes
OfficialNo Includes notes are included in this display for I87.311. Check the code and parent instructions in the Code Book.
Excludes 1
Official- chronic venous hypertension due to deep vein thrombosis (I87.0-)Inherited from I87.3
- varicose veins of lower extremities (I83.-)Inherited from I87.3
Code First
OfficialNo Code First sequencing instructions are included in this display for I87.311. Check the code and parent instructions in the Code Book.
Use Additional
Official- code to specify site and severity of ulcer (L97.-)Inherited from I87.31
Code Also
OfficialNo Code Also instructions are included in this display for I87.311. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 I87.311 an HCC code?
Yes. I87.311 (Chronic venous hypertension (idiopathic) with ulcer of right 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: I87.311 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
- I87.311
- Description
- Chronic venous hypertension (idiopathic) with ulcer of right 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
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 I87.311 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for I87.311
For I87.311, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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What This Code Means
I87.311 is the ICD-10-CM diagnosis code for chronic venous hypertension (idiopathic) with ulcer of right lower extremity. A condition where high pressure builds up in the veins of the right leg due to an unknown cause, resulting in an open sore or ulcer on that leg. I87.311 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, I87.311 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. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. 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.
An additional code from the L89 series may be needed to specify the ulcer severity and stage. For I87.311, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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 I87.311 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •An additional code from the L89 series may be needed to specify the ulcer severity and stage
- •Document the location and size of the ulcer to support medical necessity for treatment
Clinical Significance
Chronic venous hypertension (idiopathic) with ulcer of the right lower extremity indicates sustained elevated venous pressure without an identifiable secondary cause, resulting in skin breakdown and chronic ulceration. This condition reflects significant chronic vascular disease requiring ongoing wound care, compression therapy, and monitoring for progression. The ulceration component substantially increases infection risk, hospitalization rates, and overall healthcare resource consumption.
Documentation Requirements
- ✓Diagnosis of chronic venous hypertension documented
- ✓Idiopathic etiology specified (no identifiable secondary cause)
- ✓Laterality documented (right lower extremity)
- ✓Ulcer presence and characteristics described (size, location, depth, wound bed)
- ✓Evidence of chronic venous insufficiency (edema, skin changes, hemosiderin staining)
- ✓Current wound management and compression therapy plan
- ✓Exclusion of secondary causes documented if applicable
Commonly Confused Codes
- •I87.312: Left lower extremity; verify laterality matches documentation
- •I87.33x: Chronic venous hypertension with ulcer AND inflammation; use when both ulcer and inflammation are documented
- •I87.01x: Postthrombotic syndrome with ulcer; use when the venous hypertension is secondary to prior deep vein thrombosis
- •I83.0xx: Varicose veins with ulcer; different underlying pathology, use when ulcer is specifically attributed to varicose veins
- •L97.xxx: Non-pressure chronic ulcer of lower limb; use when the ulcer is not attributable to venous hypertension