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ICD-10 Guide
ICD-10 CodesI63.419

I63.419

Billable

Cerebral infarction due to embolism of unspecified middle cerebral artery

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

Code Description

ICD-10 I63.419 is a billable code used to indicate a diagnosis of cerebral infarction due to embolism of unspecified middle cerebral artery.

Key Diagnostic Point:

Cerebral infarction due to embolism of the unspecified middle cerebral artery is a critical condition characterized by the obstruction of blood flow to the brain, specifically affecting the middle cerebral artery (MCA). This artery is responsible for supplying blood to significant portions of the lateral aspect of the cerebral hemispheres, which control motor and sensory functions, speech, and cognitive abilities. Clinical presentation may include sudden onset of weakness, numbness, difficulty speaking, and visual disturbances. The disease progression can lead to irreversible brain damage if not promptly addressed, with potential complications including long-term disability or death. Diagnostic considerations involve imaging studies such as CT or MRI to confirm the presence of an infarct and to rule out hemorrhagic stroke. Additionally, identifying the source of the embolism, which may arise from cardiac conditions like atrial fibrillation or from atherosclerotic plaques, is crucial for effective management and prevention of future strokes.

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 anticoagulation therapy, rehabilitation, and management of underlying conditions.
  • Documentation requirements: Detailed clinical notes and imaging results are essential for accurate coding.
  • Coding specificity: Requires precise identification of the artery involved and the cause of the infarction.

Audit Risk Factors

  • Common coding errors: Misidentifying the artery or the cause of the infarction.
  • Documentation gaps: Incomplete clinical notes that do not specify the type of embolism.
  • Billing challenges: Potential denials if the documentation does not 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

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Cerebral infarctions significantly impact population health, contributing to morbidity and mortality rates associated with stroke. Effective management and prevention strategies are crucial for reducing healthcare utilization patterns related to stroke care. Quality measures focus on timely intervention and rehabilitation, which can improve outcomes for affected individuals and reduce the overall burden on healthcare systems.

ICD-9 vs ICD-10

Cerebral infarctions significantly impact population health, contributing to morbidity and mortality rates associated with stroke. Effective management and prevention strategies are crucial for reducing healthcare utilization patterns related to stroke care. Quality measures focus on timely intervention and rehabilitation, which can improve outcomes for affected individuals and reduce the overall burden on healthcare systems.

Reimbursement & Billing Impact

Reimbursement considerations include the need for clear clinical evidence of the cerebral infarction and its cause. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for imaging studies. Best practices include ensuring that all clinical notes are comprehensive and that imaging results are clearly linked to the diagnosis.

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 I63.419?

I63.419 covers cerebral infarction specifically due to embolism affecting the middle cerebral artery, which may result from various conditions such as atrial fibrillation, myocardial infarction, or other embolic sources.

When should I63.419 be used instead of related codes?

I63.419 should be used when the embolism's specific source is unknown or unspecified, differentiating it from codes that specify the artery or the cause of the embolism.

What documentation supports I63.419?

Documentation should include clinical findings, imaging results confirming cerebral infarction, and any relevant history of embolic events or cardiovascular conditions.