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ICD-10 Guide
ICD-10 CodesI63.319

I63.319

Billable

Cerebral infarction due to thrombosis of unspecified middle cerebral artery

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

Code Description

ICD-10 I63.319 is a billable code used to indicate a diagnosis of cerebral infarction due to thrombosis of unspecified middle cerebral artery.

Key Diagnostic Point:

Cerebral infarction due to thrombosis of the unspecified middle cerebral artery is a type of ischemic stroke characterized by the obstruction of blood flow to the brain caused by a thrombus. The middle cerebral artery (MCA) is a critical vessel supplying blood to large portions of the lateral aspect of the cerebral hemispheres, including areas responsible for motor and sensory functions, language, and cognition. Clinical presentation may include sudden onset of weakness or numbness on one side of the body, difficulty speaking, visual disturbances, and loss of coordination. Disease progression can vary; some patients may experience rapid deterioration, while others may have a more gradual onset of symptoms. Diagnostic considerations include neuroimaging studies such as CT or MRI to confirm the presence of an infarct and to rule out hemorrhagic stroke. Laboratory tests may also be performed to assess risk factors such as hyperlipidemia, hypertension, and diabetes. Timely diagnosis and intervention are crucial to minimize neurological 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 acute management with thrombolytics or anticoagulants, followed by rehabilitation.
  • Documentation requirements: Detailed clinical notes and imaging results are essential for accurate coding.
  • Coding specificity: Requires precise identification of the affected artery and the nature of the infarction.

Audit Risk Factors

  • Common coding errors: Misidentification of the affected artery or misclassification of the type of stroke.
  • Documentation gaps: Incomplete clinical notes or lack of imaging reports can lead to denials.
  • Billing challenges: Difficulty in justifying the medical necessity of treatments without thorough 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

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Cerebral infarctions significantly impact population health, contributing to morbidity and mortality associated with stroke. Effective management of this condition is crucial for improving quality measures related to stroke care and rehabilitation. Understanding the epidemiology of stroke, including risk factors and outcomes, can inform healthcare utilization patterns and guide preventive strategies in at-risk populations.

ICD-9 vs ICD-10

Cerebral infarctions significantly impact population health, contributing to morbidity and mortality associated with stroke. Effective management of this condition is crucial for improving quality measures related to stroke care and rehabilitation. Understanding the epidemiology of stroke, including risk factors and outcomes, can inform healthcare utilization patterns and guide preventive strategies in at-risk populations.

Reimbursement & Billing Impact

Reimbursement considerations include the medical necessity of imaging studies and treatments administered. Common denials may arise from insufficient documentation or failure to demonstrate the acute nature of the condition. Coders should ensure that all relevant clinical notes, imaging results, and treatment plans are clearly documented to support the claim. Best practices include using specific codes when possible and maintaining thorough records to justify the medical necessity of interventions.

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 I63.319?

I63.319 specifically covers cerebral infarction due to thrombosis of the unspecified middle cerebral artery. It encompasses cases where the exact location of the thrombus within the MCA is not specified, but the clinical presentation aligns with ischemic stroke symptoms.

When should I63.319 be used instead of related codes?

I63.319 should be used when the clinical documentation indicates a cerebral infarction due to thrombosis of the middle cerebral artery without specifying the side. If the side is known, codes I63.311 or I63.312 should be used instead.

What documentation supports I63.319?

Documentation should include clinical notes detailing the patient's symptoms, results from neuroimaging studies confirming the infarction, and any relevant laboratory findings that support the diagnosis of a thrombotic stroke.