I70.242: Atherosclerosis of native arteries of left leg with ulceration of calf

Risk adjustment

I70.242 risk-adjusts. Under the CMS-HCC V28 model it maps to these categories:

• HCC 263 Atherosclerosis of Arteries of the Extremities with Ulceration or Gangrene1.118 RAF
• HCC 383 Chronic Ulcer of Skin, Except Pressure, Not Specified as Through to Bone or Muscle0.646 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

I70.242 is named in 43 Medicare coverage policies: 41 listing it as supporting medical necessity, and 2 listing it as NOT covered. Which one applies depends on your Medicare contractor.

• A56566Billing and Coding: Outpatient Physical and Occupational Therapy Servicesnot covered
• A57067Billing and Coding: Outpatient Physical and Occupational Therapy Servicesnot covered
• A52850Billing and Coding: Cardiac Catheterization and Coronary Angiography
• A52996Billing and Coding: Routine Foot Care