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ICD-10 Guide
ICD-10 CodesI63.539

I63.539

Billable

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

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

Code Description

ICD-10 I63.539 is a billable code used to indicate a diagnosis of cerebral infarction due to unspecified occlusion or stenosis of unspecified posterior cerebral artery.

Key Diagnostic Point:

Cerebral infarction due to unspecified occlusion or stenosis of the unspecified posterior cerebral artery refers to a type of ischemic stroke resulting from a blockage or narrowing of blood vessels supplying the posterior cerebral artery (PCA). The PCA is responsible for supplying blood to the occipital lobe, inferior temporal lobe, and various deep structures of the brain. Clinical presentation may include visual disturbances, sensory deficits, and cognitive impairments, depending on the area of the brain affected. Disease progression 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 identify the infarction and assess the extent of damage. Additionally, vascular imaging may be necessary to evaluate the occlusion or stenosis of the PCA. Understanding the underlying cause of the infarction is crucial for determining appropriate management and rehabilitation strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical correlation to confirm diagnosis.
  • Treatment complexity: May involve multidisciplinary approaches including neurology, rehabilitation, and possibly surgical intervention.
  • Documentation requirements: Detailed clinical documentation is necessary to support the diagnosis and treatment plan.
  • Coding specificity: Requires precise identification of the occlusion or stenosis and its effects.

Audit Risk Factors

  • Common coding errors: Misidentification of the affected artery or occlusion type.
  • Documentation gaps: Incomplete clinical notes that do not clearly outline the diagnosis.
  • Billing challenges: Potential denials due to lack of specificity or insufficient documentation.

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

Rehabilitation 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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of I63.539 lies in its association with significant morbidity and mortality rates in affected populations. Cerebral infarctions can lead to long-term disabilities, impacting quality of life and increasing healthcare utilization. Understanding the epidemiology of strokes related to PCA occlusions is essential for developing effective prevention strategies and improving population health outcomes. Quality measures related to timely diagnosis and treatment of strokes are critical in reducing the burden of this condition.

ICD-9 vs ICD-10

The clinical significance of I63.539 lies in its association with significant morbidity and mortality rates in affected populations. Cerebral infarctions can lead to long-term disabilities, impacting quality of life and increasing healthcare utilization. Understanding the epidemiology of strokes related to PCA occlusions is essential for developing effective prevention strategies and improving population health outcomes. Quality measures related to timely diagnosis and treatment of strokes are critical in reducing the burden of this condition.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the condition and the complexity of treatment provided. Common denials may arise from insufficient documentation or lack of specificity in the diagnosis. Coders should ensure that all clinical notes, imaging reports, and treatment plans are thoroughly documented to support the claim. Best practices include regular audits of coding accuracy and ensuring that all relevant clinical information is included in the patient's 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 I63.539?

I63.539 covers cerebral infarctions resulting from unspecified occlusion or stenosis of the posterior cerebral artery, which may include conditions such as transient ischemic attacks (TIAs) and full-blown strokes affecting the PCA territory.

When should I63.539 be used instead of related codes?

I63.539 should be used when the specific artery affected is not documented or when the occlusion or stenosis is unspecified. If the documentation specifies the right or left PCA, then the corresponding codes (I63.530 or I63.531) should be used.

What documentation supports I63.539?

Documentation should include clinical findings, imaging results confirming the infarction, and any relevant history of vascular disease. Detailed notes on the patient's symptoms and neurological assessments are also critical.