ICD-10 Code I87.319: Chronic Venous Hypertension with Ulcer of Unspecified Lower Extremity – Complete Coding & Billing Guide

What Does ICD-10 Code I87.319 Mean?

ICD-10 code I87.319 describes chronic venous hypertension (idiopathic) with an ulcer of an unspecified lower extremity. It is a billable, valid diagnosis code for fiscal year 2026, effective October 1, 2025 through September 30, 2026, with no changes to its description or validity since it was introduced in FY2016.

The term “idiopathic” signals that no secondary cause — such as deep vein thrombosis — has been identified as the driver of elevated venous pressure. The “unspecified lower extremity” designation indicates that documentation does not specify whether the affected limb is the right, left, or bilateral.

Key attributes at a glance:

• Billable/specific: Yes — valid for claim submission
• Applicable setting: Inpatient and outpatient
• Laterality: Unspecified (neither right nor left documented)
• Complication captured: Ulcer present (without inflammation)
• Additional code required: Must assign an L97.- code to specify ulcer site and severity

What Conditions and Clinical Scenarios Does I87.319 Cover?

I87.319 applies when a patient presents with venous ulceration on a lower limb that is attributable to elevated venous pressure of unknown etiology — and when the provider has not documented which specific leg is affected. Clinical presentations that fall under this code include:

• Venous stasis ulcers of the lower limb with no identified DVT or varicose vein origin
• Recurrent or chronic leg ulcers linked to peripheral venous insufficiency (idiopathic)
• Skin breakdown with surrounding findings such as lipodermatosclerosis, hyperpigmentation, or hemosiderin staining
• Lower extremity ulceration with edema consistent with venous hypertension, laterality not charted
• Wound care encounters for venous ulcers where underlying etiology is idiopathic venous hypertension

What Does I87.319 Specifically Exclude?

The ICD-10-CM tabular list places important Excludes 1 restrictions on the I87.3x category. Never assign I87.319 when:

• The chronic venous hypertension is attributable to deep vein thrombosis — use I87.0x (Postthrombotic syndrome) instead
• The ulcer arises from varicose veins — use I83.0x (Varicose veins of lower extremities with ulcer) instead
• Both conditions (venous hypertension + DVT) coexist — the Excludes 1 note prohibits simultaneous coding

When Is I87.319 the Right Code to Use?

In practice, coders frequently struggle to determine whether I87.319 or a laterality-specific sibling code is appropriate — and whether inflammation changes the code entirely. Apply I87.319 when all of the following criteria are met:

1. The diagnosis is chronic venous hypertension — not acute venous disease or superficial thrombophlebitis
2. The etiology is idiopathic — no DVT or varicose vein origin is documented in the medical record
3. A venous ulcer is present and documented by the provider
4. The provider has not identified or documented which lower extremity is affected (right, left, or bilateral)
5. Inflammation is not documented alongside the ulcer — if it is, I87.339 applies
6. An L97.- code has been identified and is ready to be assigned as an additional code

How Does I87.319 Differ From the Most Commonly Confused Codes?

Auditors commonly flag I87.319 on claims where the underlying cause is documented elsewhere as DVT — always cross-reference the full encounter note before assigning any I87.3x code.

What Documentation Is Required to Support I87.319?

I87.319 carries a meaningful documentation burden because it involves two code layers: the venous hypertension itself and the accompanying ulcer. Both must be individually supported.

What Must the Provider Document in the Clinical Notes?

1. An explicit diagnosis of chronic venous hypertension — not just “venous insufficiency” or “stasis changes” (coders cannot assume venous hypertension from symptom descriptions alone)
2. Confirmation that the etiology is idiopathic — absence of DVT history or varicose vein documentation, or a provider statement ruling out secondary causes
3. Documentation of an active ulcer attributable to the venous hypertension — wound care notes, nursing assessments, or provider documentation
4. The anatomical site of the ulcer on the lower extremity to support the companion L97.- code (e.g., calf, ankle, heel)
5. The severity or depth of the ulcer to complete the L97.- specificity (limited to breakdown of skin, with fat layer exposed, with necrosis of muscle/bone, etc.)
6. Absence of laterality documentation — or a query to the provider if laterality seems clinically evident but is not charted

Which Diagnostic or Lab Results Support This Code?

While I87.319 is a clinical diagnosis code, the following findings strengthen documentation quality and support medical necessity for associated procedures:

• Duplex venous ultrasound demonstrating venous reflux or insufficiency without thrombotic etiology
• Ankle-brachial index (ABI) results ruling out arterial insufficiency as a confounding ulcer cause
• Wound assessment documentation (size, depth, tissue type, exudate) supporting L97.- companion code selection
• Photographic wound documentation in the medical record
• History and physical noting the absence of prior DVT or varicose vein diagnosis

What Is the Documentation Standard for Inpatient vs. Outpatient Settings?

How Does I87.319 Affect Medical Billing and Claims?

From a revenue cycle standpoint, I87.319 almost never stands alone on a claim. The mandatory “code also” instruction for L97.- is a significant billing consideration — missing the companion code is one of the most common reasons claims for wound care services are denied or downgraded.

Payer considerations to know:

• Medicare covers wound care services when medical necessity is established through documented vascular etiology — I87.319 supports this when paired correctly with L97.-
• LCD policies for chronic wound care (such as CMS LCD L38629 for skin substitutes) often require the venous diagnosis code to appear alongside the wound-specific code
• Claims submitted with I87.319 alone, without the L97.- companion, may trigger NCCI edit reviews or medical necessity denials
• Some commercial payers require prior authorization for advanced wound care modalities (e.g., negative pressure wound therapy, biological skin substitutes) when I87.319 is the primary diagnosis

What CPT or Procedure Codes Are Commonly Billed With I87.319?

Are There Any Prior Authorization or Coverage Restrictions?

• Compression therapy (CPT 29581) typically does not require prior auth under Medicare Part B but may under commercial plans
• Biological skin substitutes and advanced wound care products often require prior authorization and must be supported by a qualifying diagnosis including I87.319
• Durable medical equipment (compression stockings) billed under HCPCS requires separate documentation of venous insufficiency; I87.319 alone may be insufficient — verify payer-specific LCD requirements

What Coding Errors Should You Avoid With I87.319?

This code attracts a predictable set of errors that surface consistently during coding audit preparation and retrospective reviews. The most frequently encountered errors, ranked by audit risk:

1. Omitting the mandatory L97.- companion code. The tabular includes an instruction to “use additional code to specify site and severity of ulcer (L97.-).” Failing to include L97.- is an incomplete code assignment — not merely a missed opportunity for specificity.
2. Using I87.319 when laterality is documented. If the encounter note or wound care record specifies the right or left leg, I87.311 or I87.312 must be used. I87.319 is appropriate only when laterality is genuinely absent.
3. Confusing I87.319 with I87.339. When the clinical note documents both an ulcer and inflammation (e.g., periulcer cellulitis, erythema, warmth), I87.339 is required — I87.319 does not capture the inflammatory component.
4. Assigning I87.319 when DVT is documented. A concurrent or historical DVT as the underlying cause of venous hypertension redirects coding to the I87.0x (Postthrombotic syndrome) category. This is an Excludes 1 violation, not simply a coding preference.
5. Coding I87.319 from symptom language. “Stasis changes,” “venous insufficiency,” or “poor venous return” are not equivalent to a coded diagnosis of chronic venous hypertension. A provider must explicitly diagnose the condition.

What Do Auditors Look for When Reviewing Claims With I87.319?

• Confirmation that the L97.- code is present and correctly mapped to the documented wound site and severity
• Evidence that the underlying cause is truly idiopathic — auditors will cross-reference DVT history in the medical record
• Laterality consistency between the diagnosis code (I87.319 = unspecified) and the procedure code (e.g., a unilateral compression application CPT may raise flags)
• Provider signature and credentials on wound assessments used to support the diagnosis
• Alignment between the claim date of service and the wound documentation date

How Does I87.319 Relate to Other ICD-10 Codes?

Understanding I87.319’s position within the broader I87.3x family — and its relationship to adjacent vascular codes — is essential for clean claims and audit-ready documentation.

What Is the Correct Code Sequencing When I87.319 Appears With Other Diagnoses?

1. I87.319 is sequenced as the principal or primary diagnosis when the venous hypertension with ulcer is the condition chiefly responsible for the encounter
2. An L97.- code is always sequenced as an additional code immediately after I87.319 to meet the “code also” instruction
3. If wound care is the encounter reason and venous hypertension is the underlying etiology, I87.319 leads and L97.- follows — do not reverse this order
4. Secondary conditions such as diabetes mellitus (E11.-), peripheral arterial disease, or obesity may be added after the primary and companion codes if documented and clinically relevant to the encounter

Real-World Coding Scenario — How I87.319 Is Applied in Practice

A 71-year-old patient presents to an outpatient wound care clinic for follow-up treatment of a lower leg ulcer. The provider’s note documents “chronic venous hypertension (idiopathic) with active venous ulcer, lower extremity” and describes debridement of a 4 cm × 3 cm ulcer with partial thickness skin loss. The note does not specify right or left leg. Duplex ultrasound performed three months prior showed bilateral venous reflux without thrombosis. The coder must select the appropriate diagnosis and procedure codes.

Correct Code Application

• I87.319 — Chronic venous hypertension (idiopathic) with ulcer of unspecified lower extremity (primary diagnosis; laterality not documented)
• L97.909 — Non-pressure chronic ulcer of unspecified part of unspecified lower leg, unspecified severity (companion code; site and severity unspecified per documentation)
• 97597 — Debridement, open wound, first 20 sq cm (procedure; supported by wound size and debridement documentation)

Common Mistake in This Scenario

• Incorrect: Assigning I87.319 without L97.909 and submitting the claim with only the venous hypertension code
• Why it fails: The ICD-10-CM tabular instruction explicitly requires the L97.- code. Claims submitted without it are incomplete and may be denied or returned for additional information by payers conducting medical billing documentation requirements reviews

Frequently Asked Questions About ICD-10 Code I87.319

Is ICD-10 Code I87.319 Valid for Use in 2026?

ICD-10 code I87.319 is a valid, billable diagnosis code for fiscal year 2026 with no changes to its description, validity, or instructional notes since it was introduced in FY2016. Coders should confirm annual validity against the CMS ICD-10-CM tabular releases each October.

Do I Always Need to Assign an L97.- Code With I87.319?

Yes — the ICD-10-CM tabular includes a mandatory “use additional code” instruction directing coders to assign an L97.- code to specify the ulcer site and severity. Submitting I87.319 without the L97.- companion code represents an incomplete code assignment and is a known audit risk.

When Should I Use I87.319 Instead of I87.311 or I87.312?

I87.319 should only be used when provider documentation genuinely does not specify which lower extremity is affected. If the clinical note, wound assessment, or imaging report identifies the right or left leg, coders must use the laterality-specific code (I87.311 for right, I87.312 for left). According to ICD-10-CM Official Coding Guidelines principles, unspecified codes are not a substitute for available specificity.

What Is the Difference Between I87.319 and I87.339?

I87.319 applies when only an ulcer is present, with no documented inflammation. I87.339 applies when both an ulcer and inflammation are documented in the same lower extremity (unspecified laterality). Coders should review the full clinical note for language indicating periulcer erythema, warmth, or cellulitis before defaulting to I87.319.

Can I87.319 and I87.019 Be Assigned Together?

No — the I87.3x category carries an Excludes 1 note prohibiting simultaneous use with I87.0x (Postthrombotic syndrome). If the venous hypertension is attributable to a prior DVT, coding must shift entirely to the appropriate I87.0x code. Both conditions cannot be coded simultaneously in the same encounter for the same lower extremity.

Does I87.319 Support Medical Necessity for Wound Care Services?

I87.319 supports medical necessity for wound care, compression therapy, and venous duplex imaging when combined with appropriate documentation of the ulcer’s clinical characteristics. However, advanced wound care products and skin substitutes may require additional payer-specific criteria — always verify against applicable LCD policies on the CMS website before submitting claims.

Is I87.319 Appropriate When the Patient Also Has Diabetes?

I87.319 can be assigned alongside diabetes-related codes, but coders must first confirm that the ulcer’s primary etiology is venous hypertension — not diabetic peripheral angiopathy or diabetic neuropathy. If diabetes is the underlying ulcer driver, the appropriate E11.621 or E11.622 code family should lead. The AHA Coding Clinic has addressed diabetic ulcer vs. venous ulcer sequencing in guidance relevant to mixed-etiology wound presentations.

Key Takeaways

Every coder working with I87.319 should keep the following points front of mind:

• I87.319 is a billable code for chronic venous hypertension (idiopathic) with lower extremity ulcer — but laterality is genuinely unspecified, not a placeholder for unreviewed documentation
• The L97.- companion code is mandatory, not optional — always assign it to specify ulcer site and severity
• Excludes 1 rules prohibit I87.319 when DVT (I87.0x) or varicose veins (I83.x) are the documented cause
• Use I87.339 — not I87.319 — when inflammation accompanies the ulcer
• The term “idiopathic” is load-bearing: if a cause is documented, a different code family likely applies
• Documentation must include an explicit provider diagnosis of chronic venous hypertension — symptom descriptions alone do not support this code
• Annual verification against the ICD-10-CM Official Coding Guidelines is essential; code changes are published each October by CMS

For deeper guidance on coding audit preparation and revenue cycle compliance related to vascular diagnosis codes, review the CMS ICD-10-CM tabular and applicable LCD policies for your MAC jurisdiction.