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ICD-10 Guide
ICD-10 CodesI63.51

I63.51

Non-billable

Cerebral infarction due to unspecified occlusion or stenosis of middle cerebral artery

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

Code Description

ICD-10 I63.51 is a used to indicate a diagnosis of cerebral infarction due to unspecified occlusion or stenosis of middle cerebral artery.

Key Diagnostic Point:

Cerebral infarction due to unspecified occlusion or stenosis of the middle cerebral artery (MCA) is a type of ischemic stroke characterized by the interruption of blood flow to the brain tissue supplied by the MCA. This condition often presents with sudden onset of neurological deficits, which may include weakness or numbness on one side of the body, difficulty speaking, or visual disturbances. The MCA is a critical artery that supplies a significant portion of the lateral aspect of the cerebral hemisphere, and occlusion or stenosis can result from various factors, including atherosclerosis, embolism, or thrombosis. Disease progression can lead to irreversible brain damage if not promptly addressed, emphasizing the importance of rapid diagnosis and intervention. Diagnostic considerations include neuroimaging studies such as CT or MRI to confirm the presence of infarction and to rule out hemorrhagic stroke. The clinical presentation, imaging findings, and patient history are crucial for accurate diagnosis and management.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical assessment.
  • Treatment complexity: May involve acute interventions like thrombolysis or surgical options.
  • Documentation requirements: Detailed clinical notes and imaging reports are essential.
  • Coding specificity: Requires precise identification of the occlusion site and type.

Audit Risk Factors

  • Common coding errors: Misidentifying the artery involved or failing to document the type of occlusion.
  • Documentation gaps: Incomplete clinical notes or missing imaging reports.
  • Billing challenges: Denials may arise from insufficient documentation or incorrect coding.

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 occlusion of the middle cerebral artery has significant clinical implications, contributing to a substantial burden of morbidity and mortality in the population. It is a leading cause of disability and can impact healthcare utilization patterns, including increased hospital admissions and rehabilitation services. Understanding the epidemiology of this condition is crucial for developing effective prevention strategies and improving quality measures in stroke care.

ICD-9 vs ICD-10

Cerebral infarction due to occlusion of the middle cerebral artery has significant clinical implications, contributing to a substantial burden of morbidity and mortality in the population. It is a leading cause of disability and can impact healthcare utilization patterns, including increased hospital admissions and rehabilitation services. Understanding the epidemiology of this condition is crucial for developing effective prevention strategies and improving quality measures in stroke care.

Reimbursement & Billing Impact

Reimbursement considerations include the need for comprehensive documentation that outlines the patient's clinical presentation, imaging studies performed, and treatment provided. Common denials may occur if the documentation does not clearly establish the diagnosis or if the coding does not align with the services billed. Best practices include ensuring that all relevant clinical information is captured in the medical record and that coding is performed in accordance with the latest guidelines.

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 I63.51?

I63.51 covers cerebral infarction specifically due to occlusion or stenosis of the middle cerebral artery, which may arise from atherosclerotic disease, embolic events, or thrombosis. It does not include infarctions due to other causes or arteries.

When should I63.51 be used instead of related codes?

I63.51 should be used when the infarction is specifically due to occlusion or stenosis of the middle cerebral artery and when other codes do not accurately reflect the clinical scenario, such as I63.50 for unspecified occlusion.

What documentation supports I63.51?

Documentation should include a detailed patient history, clinical examination findings, neuroimaging results confirming the infarction, and any relevant laboratory tests that support the diagnosis of occlusion or stenosis.