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ICD-10 Guide
ICD-10 CodesI63.413

I63.413

Billable

Cerebral infarction due to embolism of bilateral middle cerebral arteries

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

Code Description

ICD-10 I63.413 is a billable code used to indicate a diagnosis of cerebral infarction due to embolism of bilateral middle cerebral arteries.

Key Diagnostic Point:

I63.413 refers to cerebral infarction due to embolism of bilateral middle cerebral arteries. This condition occurs when a blood clot or other debris travels through the bloodstream and lodges in the middle cerebral arteries, which supply blood to significant portions of the brain. Clinically, patients may present with sudden onset of neurological deficits, including weakness or paralysis on one side of the body, speech difficulties, and sensory loss. The middle cerebral arteries are crucial for motor and sensory functions, and bilateral involvement can lead to more severe impairments. Disease progression can vary; some patients may experience transient ischemic attacks (TIAs) before a full-blown stroke, while others may have a sudden 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. Additionally, risk factors such as atrial fibrillation, carotid artery disease, and other cardiovascular conditions should be assessed to manage and prevent further embolic events.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical evaluation to confirm diagnosis.
  • Treatment complexity: May involve acute management with thrombolytics or anticoagulants and long-term rehabilitation.
  • Documentation requirements: Detailed clinical notes and imaging reports are essential.
  • Coding specificity: Requires precise coding to differentiate from other types of strokes.

Audit Risk Factors

  • Common coding errors: Misidentification of the type of stroke or embolism.
  • Documentation gaps: Incomplete clinical notes or lack of imaging reports.
  • Billing challenges: Potential denials due to insufficient documentation or incorrect code selection.

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 significantly impact population health, contributing to morbidity and mortality rates associated with stroke. Quality measures focus on timely intervention and rehabilitation, which can improve outcomes and reduce long-term disability. Understanding healthcare utilization patterns for this condition is crucial for resource allocation and improving care delivery, as timely treatment can greatly influence recovery and quality of life.

ICD-9 vs ICD-10

Cerebral infarctions due to embolism significantly impact population health, contributing to morbidity and mortality rates associated with stroke. Quality measures focus on timely intervention and rehabilitation, which can improve outcomes and reduce long-term disability. Understanding healthcare utilization patterns for this condition is crucial for resource allocation and improving care delivery, as timely treatment can greatly influence recovery and quality of life.

Reimbursement & Billing Impact

Reimbursement considerations include the complexity of care, potential for rehabilitation services, and follow-up visits. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for imaging or treatment. Best practices include ensuring all clinical notes are complete, accurate, and reflect the severity of the condition, as well as using appropriate modifiers when necessary.

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 I63.413?

I63.413 covers cerebral infarction specifically due to embolism affecting both middle cerebral arteries. This includes conditions resulting from cardiac sources like atrial fibrillation or other embolic phenomena leading to ischemic strokes.

When should I63.413 be used instead of related codes?

I63.413 should be used when there is confirmed bilateral middle cerebral artery involvement due to embolism. If only one artery is affected, codes like I63.412 should be considered.

What documentation supports I63.413?

Documentation should include detailed clinical assessments, imaging results confirming bilateral cerebral infarction, and any relevant history of embolic sources such as cardiac conditions.