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. Look up the whole chart to see which of its HCCs the hierarchy would zero.

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 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
• A57305Billing and Coding: Varicose Veins of the Lower Extremity, Treatment ofnot covered
• A52996Billing and Coding: Routine Foot Care