ICD-10 Code I74.5: Embolism and thrombosis of iliac artery

Key Takeaways

ICD-10 Code I74.5 describes embolism and thrombosis of iliac artery and is a billable, valid-for-submission ICD-10-CM diagnosis code as of FY2026.

The code covers two Applicable To terms: embolism of iliac artery and thrombosis of iliac artery. Both map to I74.5 with no subcategory split.

Every excludes note under I74.5 is an Excludes2, not an Excludes1, so atheroembolism or pulmonary embolism may be coded alongside it when both are documented.

Practice management software like Pabau centralizes clinical documentation, helping vascular care teams keep the detailed records coders need for accurate I74.5 assignment.

Arterial occlusion in the iliac territory is one of the more consequential vascular diagnoses a coder will encounter. Missed or miscoded, it delays prior authorization, triggers payer denials, and leaves clinicians without the documentation trail they need for high-cost interventions.

ICD-10 Code I74.5 is the correct billable code for both embolism and thrombosis of the iliac artery, and getting it right matters every time it appears in a chart.

This reference covers everything medical coders and billers need: code details, applicable to terms, excludes notes, clinical context, sequencing guidelines, the I74 parent code hierarchy, related sibling codes, code history, and commonly paired CPT procedure codes.

ICD-10 Code I74.5: Definition and code details

ICD-10 Code I74.5 is a billable, specific ICD-10-CM diagnosis code that represents embolism and thrombosis of the iliac artery. It is valid for claim submission and has been active in the ICD-10-CM tabular list since FY2016 with no revisions through FY2026. The CMS ICD-10 codes page confirms its active billable status for the current fiscal year.

The table below summarizes the key code attributes coders and billers need at a glance. Related codes such as I76 follow the same tabular structure.

Applicable to notes for I74.5

The official CMS Applicable To notes define which conditions map to ICD-10 Code I74.5. These inclusion terms are not separate codes. They are clinical expressions that all resolve to I74.5 as the correct diagnosis code. Accurate clinical documentation workflows should capture the exact presentation to support the Applicable To mapping.

• Embolism of iliac artery – an occlusion caused by a migrating clot or debris lodging in the iliac arterial tree
• Thrombosis of iliac artery – in situ clot formation within the iliac artery resulting in partial or complete occlusion

Both terms map to the same code with no further subcategory differentiation. Whether the operative or discharge note documents embolism or thrombosis, I74.5 is the appropriate code in either case. Coders do not need to choose between two sibling codes based on mechanism.

Excludes notes for ICD-10 Code I74.5

Excludes notes tell coders which related diagnoses are conceptually distinct from I74.5 and whether they may still be reported on the same claim. Confusing an Excludes1 with an Excludes2 (or vice versa) is one of the most common sources of coding errors in vascular claims. The CDC/NCHS ICD-10-CM web tool displays the full excludes structure for I74 and its subcodes.

I74.5 inherits its Excludes notes from parent code I74, and every one of them is an Excludes2 – there is no Excludes1 note anywhere under I74.

That means none of the conditions below is mutually exclusive with I74.5. Each is a distinct embolism or thrombosis site with its own code, and it may be reported alongside I74.5 whenever the documentation independently supports both diagnoses.

Getting the Excludes1-versus-Excludes2 distinction right matters for vascular cases. An Excludes1 note means two conditions can never be coded together. An Excludes2 note, like every note listed above, means the conditions are simply distinct and may both be reported when documentation supports each one.

I74 also carries a Code First instruction: when embolism or thrombosis of the iliac artery is documented as complicating an abortion, ectopic pregnancy, or molar pregnancy (O00-O07, O08.2), or as complicating pregnancy, childbirth, and the puerperium (O88.-), coders must sequence the applicable O-code first, ahead of I74.5.

Coders should use digital intake forms that capture the precise mechanism and anatomical site at the point of care, so co-occurring diagnoses in different vascular beds are captured rather than dropped.

Clinical context: Embolism and thrombosis of the iliac artery

The iliac arteries (common, internal, and external) supply blood to the lower limbs, pelvis, and gluteal region. Occlusion of these vessels, whether by embolism or in situ thrombosis, produces a distinct clinical picture that coding staff need to understand to assign and query I74.5 accurately.

According to the AAPC ICD-10-CM code reference, I74.5 falls within the arterial embolism and thrombosis category, which covers non-atherosclerotic occlusion mechanisms distinct from peripheral arterial disease coded under I70. That distinction matters clinically and from a coding standpoint. Here is how the two mechanisms differ:

Both presentations code to I74.5 regardless of mechanism. However, precise documentation of the mechanism is important because it influences co-coding decisions, such as recording atrial fibrillation as a contributing condition when embolism is confirmed. Consistent documentation practices across the care team reduce query burden at the back end of the revenue cycle, the same discipline coders rely on for related codes like I26.

Diagnosis coding guidelines for ICD-10 Code I74.5

Using I74.5 correctly requires more than confirming it is billable. The ICD-10-CM Official Guidelines for Coding and Reporting, maintained by the National Center for Health Statistics (NCHS) and CMS, set the rules for when and how to sequence it. HIPAA-compliant documentation practices require that diagnosis codes reflect the clinical record precisely.

1. Confirm the anatomical site. I74.5 is specific to the iliac artery (common, internal, or external). Femoral or popliteal thrombosis uses different codes within the I74 block (I74.3 for lower extremity arteries, excluding iliac). Verify the vascular imaging or operative note before assigning.
2. Confirm the mechanism is non-atherosclerotic. If the underlying disease is atherosclerosis of the iliac vessels, peripheral artery disease codes (I70.x) should be considered instead. I74.5 is appropriate when the occlusion is thromboembolic, not a direct result of plaque-based occlusive disease.
3. Sequence correctly for inpatient admissions. When the patient is admitted for iliac artery embolism or thrombosis, I74.5 is generally the principal diagnosis. If the procedure is performed to treat this condition, sequence accordingly per the general coding guidelines on principal diagnosis selection.
4. Add contributing cause codes. When atrial fibrillation (I48.-) or hypercoagulable state (D68.5x) is documented as a contributing or underlying cause, code those conditions additionally as secondary diagnoses. Documentation software used by the billing team should retain full clinical detail so every contributing diagnosis can be coded without truncation between the record and the claim.
5. Code atheroembolism separately when documented. Atheroembolism (I75.-) carries an Excludes2 note under I74, meaning it is a distinct diagnosis: use I75.- when cholesterol or atheroembolism is the documented mechanism, and report it alongside I74.5 only if both conditions are independently confirmed.

Parent code: I74 arterial embolism and thrombosis

I74.5 sits within the I74 arterial embolism and thrombosis category, which covers non-atherosclerotic occlusion across multiple arterial territories. Understanding the full I74 hierarchy helps coders select the most specific code when the documentation identifies a different arterial site. These codes are also referenced in physical therapy EMR systems for post-procedure rehabilitation coding contexts.

The differentiation between I74.3 (lower extremity arteries) and I74.5 (iliac artery) is clinically significant. The iliac vessels are proximal to the femoral bifurcation. A coder seeing “lower extremity ischemia” without further specification should query the clinician rather than default to I74.3.

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Sibling and related codes for arterial embolism and thrombosis

Coders working with I74.5 frequently need to reference adjacent codes within the I70-I79 block. The table below covers the most commonly encountered sibling and related codes. Use the CrossCoder CPT-to-ICD crosswalk to verify procedure-to-diagnosis medical necessity pairings for vascular intervention claims. Codes like I71.9 follow this same parent-sibling architecture within the broader I70-I79 block.

ICD-10-CM code history for I74.5

I74.5 has a straightforward code history with no revisions since its introduction. Coders can rely on it as a stable code with no crosswalk requirements from prior fiscal years. The EHR integration systems that vascular billing teams rely on to reference ICD-10-CM codes should reflect this stable status without requiring annual mapping updates for I74.5 specifically.

Common CPT codes used with ICD-10 Code I74.5

When I74.5 is the primary diagnosis, the procedure codes submitted on the same claim reflect the intervention performed for the iliac embolism or thrombosis. The CMS Physician Fee Schedule lookup tool allows coders to verify RVU values and reimbursement amounts for each of these codes by geographic location.

Note: CPT code pairing requirements depend on payer, clinical context, and NCCI edit rules. The table below reflects commonly reported procedure codes in vascular cases involving iliac embolism or thrombosis. Verify specific pairings against current NCCI edits and payer policy before submission, and retain full operative note detail in the record to support medical necessity on review.

Conclusion

Iliac artery thromboembolism is a high-acuity vascular event, and ICD-10 Code I74.5 is the single billable code for both mechanisms. Getting the Excludes2 notes right – especially recognizing that atheroembolism at I75.- is a distinct, separately reportable diagnosis rather than a mutually exclusive one – prevents the most common coding errors for this diagnosis.

Pabau centralizes clinical documentation, helping practices keep the detailed records that support I74.5 alongside any contributing-cause codes. To see how Pabau handles vascular and surgical practice documentation, explore practice management software built for clinical complexity.

Primary care practices are often the first to flag limb ischemia symptoms during a routine visit, before a vascular referral is even made. General practice software helps those teams document the red flags and track the referral, so the record that reaches the vascular team already supports accurate I74.5 assignment downstream.

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