I70.539 — Atherosclerosis of nonautologous biological bypass graft(s) of the right leg with ulceration of unspecified site

Risk adjustment

I70.539 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.

Medicare coverage

I70.539 is named in 7 Medicare coverage policies — 5 listing it as supporting medical necessity, and 2 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

• 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
• A53064Billing and Coding: Outpatient Occupational Therapy