I87.019 — Postthrombotic syndrome with ulcer of unspecified lower extremity

Risk adjustment

I87.019 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• 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

I87.019 is named in 5 Medicare coverage policies — 2 listing it as supporting medical necessity, and 3 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
• A57305Billing and Coding: Varicose Veins of the Lower Extremity, Treatment ofnot covered
• A52996Billing and Coding: Routine Foot Care