I87.031: Postthrombotic syndrome with ulcer and inflammation of right lower extremity

Risk adjustment

I87.031 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

I87.031 is named in 19 Medicare coverage policies: 15 listing it as supporting medical necessity, and 4 listing it as NOT covered. Which one applies depends on your Medicare contractor.

• A52870Billing and Coding: Treatment of Varicose Veins of the Lower Extremitynot covered
• 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