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ICD-10 Guide
ICD-10 CodesI63.519

I63.519

Billable

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

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

Code Description

ICD-10 I63.519 is a billable code used to indicate a diagnosis of cerebral infarction due to unspecified occlusion or stenosis of unspecified middle cerebral artery.

Key Diagnostic Point:

Cerebral infarction due to unspecified occlusion or stenosis of the unspecified middle cerebral artery is a type of ischemic stroke that occurs when blood flow to a part of the brain is obstructed, leading to tissue death. The middle cerebral artery (MCA) is one of the main arteries supplying blood to the lateral aspects of the cerebral hemispheres, and its occlusion can result in significant neurological deficits. Clinical presentation may include sudden onset of weakness, numbness, difficulty speaking, or loss of coordination. The progression of the disease 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. The unspecified nature of the occlusion or stenosis indicates that the precise cause of the blockage has not been determined, which may complicate treatment and management strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical assessment to confirm diagnosis.
  • Treatment complexity: Management may involve anticoagulation, rehabilitation, and monitoring for complications.
  • Documentation requirements: Detailed clinical notes and imaging reports are necessary for accurate coding.
  • Coding specificity: The unspecified nature of the code may lead to challenges in identifying the exact cause of the infarction.

Audit Risk Factors

  • Common coding errors: Misidentification of the type of stroke or artery involved.
  • Documentation gaps: Incomplete clinical notes or lack of imaging results.
  • Billing challenges: Potential denials due to insufficient documentation or lack of specificity.

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, including those coded as I63.519, have significant clinical implications, affecting patient quality of life and increasing healthcare utilization. The incidence of strokes is a major public health concern, contributing to morbidity and mortality rates. Understanding the epidemiology of strokes can help healthcare providers implement preventive measures and improve outcomes through targeted interventions.

ICD-9 vs ICD-10

Cerebral infarctions, including those coded as I63.519, have significant clinical implications, affecting patient quality of life and increasing healthcare utilization. The incidence of strokes is a major public health concern, contributing to morbidity and mortality rates. Understanding the epidemiology of strokes can help healthcare providers implement preventive measures and improve outcomes through targeted interventions.

Reimbursement & Billing Impact

Reimbursement considerations include the need for clear evidence of the diagnosis and the medical necessity of services rendered. Common denials may arise from insufficient documentation or failure to demonstrate the need for imaging studies. Best practices include ensuring that all clinical notes are complete 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 I63.519?

I63.519 covers cerebral infarctions resulting from occlusion or stenosis of the middle cerebral artery without specifying the cause, which may include thromboembolic events or atherosclerosis.

When should I63.519 be used instead of related codes?

I63.519 should be used when the occlusion or stenosis of the middle cerebral artery is confirmed but the specific cause is unknown. If the cause is identified, a more specific code should be selected.

What documentation supports I63.519?

Documentation should include clinical findings, imaging results confirming the cerebral infarction, and any relevant history that may indicate risk factors for stroke.