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ICD-10 Guide
ICD-10 CodesI63.42

I63.42

Non-billable

Cerebral infarction due to embolism of anterior cerebral artery

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

Code Description

ICD-10 I63.42 is a used to indicate a diagnosis of cerebral infarction due to embolism of anterior cerebral artery.

Key Diagnostic Point:

Cerebral infarction due to embolism of the anterior cerebral artery (ACA) occurs when a blood clot or other debris travels through the bloodstream and lodges in the ACA, leading to a reduction or cessation of blood flow to the brain tissue supplied by this artery. Clinically, patients may present with sudden onset of neurological deficits, including weakness or paralysis on one side of the body, sensory loss, speech difficulties, and cognitive impairments. The ACA supplies the medial portions of the frontal lobes and the superior medial parietal lobes, which are critical for motor control and sensory processing. Disease progression can vary; some patients may experience transient ischemic attacks (TIAs) prior to a full-blown infarction, while others may have a more insidious onset. Diagnostic considerations include neuroimaging techniques such as CT or MRI to visualize the infarct and assess the extent of brain damage. Additionally, vascular imaging may be performed to identify the source of the embolism, which could be cardiac in origin or due to atherosclerotic disease.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical correlation to confirm the diagnosis.
  • Treatment complexity: Management may involve anticoagulation, rehabilitation, and addressing underlying cardiovascular risk factors.
  • Documentation requirements: Detailed clinical notes and imaging reports are necessary for accurate coding.
  • Coding specificity: Requires precise identification of the embolic event and affected artery.

Audit Risk Factors

  • Common coding errors: Misidentifying the type of stroke (ischemic vs. hemorrhagic).
  • Documentation gaps: Incomplete clinical notes regarding the patient's history and risk factors.
  • Billing challenges: Potential denials if documentation does not support the diagnosis or if the embolic source is not clearly identified.

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 anterior cerebral artery have significant clinical implications, affecting patient morbidity and mortality. The condition contributes to a substantial burden on healthcare systems, with increased hospitalizations and rehabilitation needs. Understanding the epidemiology of this condition is vital for public health initiatives aimed at reducing stroke incidence through better management of cardiovascular risk factors.

ICD-9 vs ICD-10

Cerebral infarctions due to embolism of the anterior cerebral artery have significant clinical implications, affecting patient morbidity and mortality. The condition contributes to a substantial burden on healthcare systems, with increased hospitalizations and rehabilitation needs. Understanding the epidemiology of this condition is vital for public health initiatives aimed at reducing stroke incidence through better management of cardiovascular risk factors.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the diagnosis is supported by appropriate imaging and clinical findings. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for the imaging studies performed. It is crucial to follow coding best practices, including using the most specific codes available and ensuring that all relevant clinical information is included in the medical record.

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 I63.42?

I63.42 specifically covers cerebral infarctions resulting from embolisms that occlude the anterior cerebral artery. This includes emboli originating from cardiac sources, such as atrial fibrillation, or from atherosclerotic plaques that dislodge and travel to the ACA.

When should I63.42 be used instead of related codes?

I63.42 should be used when the cerebral infarction is confirmed to be due to an embolic event affecting the anterior cerebral artery. It is distinct from I63.41, which is used for thrombosis, and requires documentation of the embolic source.

What documentation supports I63.42?

Documentation should include clinical findings, imaging results confirming the infarction, and any relevant history of embolic sources, such as cardiac conditions or prior TIAs. Detailed notes on the patient's neurological status and treatment plan are also essential.