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ICD-10 Guide
ICD-10 CodesI63.13

I63.13

Non-billable

Cerebral infarction due to embolism of carotid artery

BILLABLE STATUSNo
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 I63.13 is a used to indicate a diagnosis of cerebral infarction due to embolism of carotid artery.

Key Diagnostic Point:

Cerebral infarction due to embolism of the carotid artery occurs when a blood clot or other debris travels through the bloodstream and lodges in the carotid artery, obstructing blood flow to the brain. This can lead to ischemic stroke, characterized by sudden onset of neurological deficits, which may include weakness, speech difficulties, and loss of coordination. The carotid arteries, located on either side of the neck, are crucial for supplying oxygenated blood to the brain. Risk factors for embolism include atrial fibrillation, carotid artery disease, and other cardiovascular conditions. Disease progression can vary; some patients may experience transient ischemic attacks (TIAs) before a full stroke, while others may present with acute symptoms. Diagnostic considerations include imaging studies such as CT or MRI to confirm the presence of an infarct and Doppler ultrasound to assess carotid artery patency. Timely intervention is critical to minimize brain damage and improve outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical assessment to confirm diagnosis.
  • Treatment complexity: May involve anticoagulation therapy, surgical intervention, or rehabilitation.
  • Documentation requirements: Detailed clinical notes and imaging reports are essential.
  • Coding specificity: Requires precise documentation of the cause and location of the infarction.

Audit Risk Factors

  • Common coding errors: Misidentifying the cause of the infarction or failing to document the embolic source.
  • Documentation gaps: Incomplete clinical notes that do not specify the nature of the embolism.
  • Billing challenges: Potential denials due to lack of specificity in documentation.

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Cardiology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related ICD-10 Codes

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Cerebral infarctions due to embolism of the carotid artery significantly impact population health, contributing to morbidity and mortality associated with stroke. Effective management and prevention strategies can reduce healthcare utilization and improve quality measures in stroke care. Understanding the epidemiology of this condition helps in identifying at-risk populations and implementing targeted interventions to reduce the incidence of strokes.

ICD-9 vs ICD-10

Cerebral infarctions due to embolism of the carotid artery significantly impact population health, contributing to morbidity and mortality associated with stroke. Effective management and prevention strategies can reduce healthcare utilization and improve quality measures in stroke care. Understanding the epidemiology of this condition helps in identifying at-risk populations and implementing targeted interventions to reduce the incidence of strokes.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the severity of the stroke and associated treatments. Common denials may arise from insufficient documentation or lack of specificity in the diagnosis. Coders should ensure that all relevant clinical details are captured to support the medical necessity of services rendered, and they should be familiar with payer-specific guidelines to avoid billing challenges.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for I00-I99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for I00-I99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by I63.13?

I63.13 specifically covers cerebral infarction resulting from embolism originating from the carotid artery. This includes emboli from atherosclerotic plaques or thrombi formed in the heart due to arrhythmias like atrial fibrillation.

When should I63.13 be used instead of related codes?

I63.13 should be used when the cerebral infarction is specifically due to an embolism from the carotid artery, as opposed to other causes such as thrombosis or unspecified occlusions.

What documentation supports I63.13?

Documentation should include clinical findings, imaging results confirming the cerebral infarction, and evidence of embolic source, such as carotid Doppler studies or cardiac evaluations.