ICD-10 I83.204
Billable / Specific HCC v28: 107 CCVaricose veins of unspecified lower extremity with both ulcer of heel and midfoot and inflammation
About ICD-10-CM I83.204
ICD-10-CM code I83.204 represents Varicose veins of unspecified lower extremity with both ulcer of heel and midfoot and inflammation. This is a billable/specific code in the Circulatory System chapter (block I83). The 2026 edition of ICD-10-CM I83.204 became effective on October 1, 2025.
Coding Tips for I83.204
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
I83.204 is a CMS-HCC v28 risk-adjustment code (category 107). 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.
I83.204 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.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under I83.204. Per CMS ICD-10-CM Tabular 2026.
- Varicose veins of unspecified lower extremity with both ulcer of plantar surface of midfoot and inflammation
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 Varicose veins of unspecified lower extremity with both ulcer of heel and midfoot and inflammation. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for I83.204
Local Coverage Determinations (LCDs) from CMS MACs that list I83.204 as a covered diagnosis.
Showing top 10 of 17 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing I83.204.
3 Medicare
CPT Codes Commonly Billed with I83.204
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.
Convert I83.204 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| I83.204 | 4542 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To I83.204
Other codes in section I80-I89 (Diseases of veins, lymphatic vessels and lymph nodes, not elsewhere classified).
ICD-10 I83.204, Billing FAQ
Is ICD-10 code I83.204 billable? +
Yes, I83.204 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to I83.204? +
ICD-10 I83.204 includes: Varicose veins of unspecified lower extremity with both ulcer of plantar surface of midfoot and inflammation.
Does I83.204 affect Medicare Advantage HCC risk adjustment? +
Yes. I83.204 maps to CMS-HCC v28 category 107. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is I83.204 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.
What ICD-9 codes does I83.204 map to? +
Per CMS GEMs, I83.204 maps to ICD-9 codes: 4542. Useful for legacy data review and historical claim analysis.
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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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