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ICD-10 Guide
ICD-10 CodesI63.31

I63.31

Non-billable

Cerebral infarction due to thrombosis of middle cerebral artery

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

Code Description

ICD-10 I63.31 is a used to indicate a diagnosis of cerebral infarction due to thrombosis of middle cerebral artery.

Key Diagnostic Point:

Cerebral infarction due to thrombosis of the middle cerebral artery (MCA) is a critical condition characterized by the obstruction of blood flow to the brain, specifically affecting the MCA territory. This artery supplies a significant portion of the lateral aspect of the cerebral hemisphere, including areas responsible for motor and sensory functions, language, and cognition. Clinical presentation may include sudden onset of weakness or numbness, particularly on one side of the body, difficulty speaking, and visual disturbances. The disease progression can vary; some patients may experience rapid deterioration, while others may have a more gradual onset of symptoms. Diagnostic considerations include neuroimaging techniques such as CT or MRI scans to confirm the presence of an infarct and to rule out hemorrhagic stroke. Risk factors for MCA thrombosis include hypertension, diabetes, hyperlipidemia, and atrial fibrillation. Prompt diagnosis and management are crucial to minimize neurological deficits and improve outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical assessment to differentiate from other stroke types.
  • Treatment complexity: May involve acute interventions like thrombolysis or thrombectomy, along with long-term management.
  • Documentation requirements: Detailed clinical notes and imaging reports are essential for accurate coding.
  • Coding specificity: Requires precise identification of the infarction's location and cause.

Audit Risk Factors

  • Common coding errors: Misidentification of the type of stroke or incorrect coding of the infarct location.
  • Documentation gaps: Incomplete clinical notes or lack of imaging reports can lead to coding inaccuracies.
  • Billing challenges: Potential for denials if documentation does not clearly support the diagnosis.

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

Emergency Medicine

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 infarction due to thrombosis of the middle cerebral artery significantly impacts population health, contributing to high morbidity and mortality rates associated with stroke. Effective management and timely intervention can improve patient outcomes and reduce healthcare utilization. Quality measures focus on rapid diagnosis and treatment, as well as secondary prevention strategies to mitigate future strokes. Epidemiologically, this condition highlights the importance of addressing risk factors such as hypertension and diabetes in at-risk populations.

ICD-9 vs ICD-10

Cerebral infarction due to thrombosis of the middle cerebral artery significantly impacts population health, contributing to high morbidity and mortality rates associated with stroke. Effective management and timely intervention can improve patient outcomes and reduce healthcare utilization. Quality measures focus on rapid diagnosis and treatment, as well as secondary prevention strategies to mitigate future strokes. Epidemiologically, this condition highlights the importance of addressing risk factors such as hypertension and diabetes in at-risk populations.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the condition and the complexity of treatment provided. Common denials may arise from insufficient documentation or failure to meet medical necessity criteria. Best practices include ensuring that all clinical notes, imaging results, and treatment plans are thoroughly documented and aligned with coding guidelines to facilitate smooth billing processes.

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 I63.31?

I63.31 specifically covers cerebral infarction resulting from thrombosis of the middle cerebral artery, which may manifest as ischemic stroke with various neurological deficits.

When should I63.31 be used instead of related codes?

I63.31 should be used when the infarction is confirmed to be due to thrombosis of the middle cerebral artery, as opposed to other types of strokes or occlusions.

What documentation supports I63.31?

Documentation should include clinical findings, imaging results confirming the infarction, and any relevant history of vascular disease or risk factors.