ICD-10 I80.243
Billable / Specific HCC v28: 108 CCPhlebitis and thrombophlebitis of peroneal vein, bilateral
About ICD-10-CM I80.243
ICD-10-CM code I80.243 represents Phlebitis and thrombophlebitis of peroneal vein, bilateral. This is a billable/specific code in the Circulatory System chapter (block I80). The 2026 edition of ICD-10-CM I80.243 became effective on October 1, 2025.
Coding Tips for I80.243
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
I80.243 is a CMS-HCC v28 risk-adjustment code (category 108). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
I80.243 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Inpatient DRG Impact, CC
codes Phlebitis and thrombophlebitis of peroneal vein, bilateral. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for I80.243
Local Coverage Determinations (LCDs) from CMS MACs that list I80.243 as a covered diagnosis.
Showing top 10 of 129 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing I80.243.
5 Medicare
CPT Codes Commonly Billed with I80.243
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Codes Adjacent To I80.243
Other codes in section I80-I89 (Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified).
ICD-10 I80.243, Billing FAQ
Is ICD-10 code I80.243 billable? +
Yes, I80.243 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does I80.243 affect Medicare Advantage HCC risk adjustment? +
Yes. I80.243 maps to CMS-HCC v28 category 108. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is I80.243 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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