I87.313: Chronic venous hypertension (idiopathic) with ulcer of bilateral lower extremity

Risk adjustment

I87.313 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

I87.313 is named in 24 Medicare coverage policies: 22 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
• A52870Billing and Coding: Treatment of Varicose Veins of the Lower Extremity
• A52993Billing and Coding: Peripheral Venous Ultrasound