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ICD-10 Guide
ICD-10 CodesI65.22

I65.22

Billable

Occlusion and stenosis of left carotid artery

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

Code Description

ICD-10 I65.22 is a billable code used to indicate a diagnosis of occlusion and stenosis of left carotid artery.

Key Diagnostic Point:

I65.22 refers to the occlusion and stenosis of the left carotid artery, a critical condition affecting the vascular system. The carotid arteries are major blood vessels that supply blood to the brain, neck, and face. Stenosis occurs when these arteries become narrowed due to atherosclerosis, which is the buildup of fatty deposits, cholesterol, and other substances in the arterial walls. Patients may present with symptoms such as transient ischemic attacks (TIAs), stroke, or other neurological deficits, depending on the severity of the occlusion. The disease progression can lead to significant morbidity, including permanent neurological damage or death if not addressed promptly. Diagnostic considerations include imaging studies such as Doppler ultrasound, CT angiography, or MR angiography to assess blood flow and identify the degree of stenosis. Early detection and management are crucial to prevent serious complications, making it essential for healthcare providers to recognize the signs and symptoms associated with this condition.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical evaluation to confirm diagnosis.
  • Treatment complexity: May involve medical management, lifestyle changes, or surgical interventions such as carotid endarterectomy or stenting.
  • Documentation requirements: Detailed clinical documentation is necessary to support the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to differentiate from other carotid artery conditions.

Audit Risk Factors

  • Common coding errors: Misidentification of laterality or failure to document the severity of stenosis.
  • Documentation gaps: Incomplete clinical notes that do not support the diagnosis or treatment.
  • Billing challenges: Potential denials due to lack of supporting evidence for the necessity of procedures.

Specialty Focus

Medical Specialties

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

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

Related ICD-10 Codes

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CPT Code

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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

The clinical significance of I65.22 lies in its potential to lead to serious outcomes such as stroke, which can significantly impact population health. Early diagnosis and intervention can reduce healthcare utilization and improve quality measures related to stroke prevention. Epidemiologically, carotid artery stenosis is prevalent in populations with risk factors such as hypertension, diabetes, and hyperlipidemia, making awareness and management of this condition crucial for public health.

ICD-9 vs ICD-10

The clinical significance of I65.22 lies in its potential to lead to serious outcomes such as stroke, which can significantly impact population health. Early diagnosis and intervention can reduce healthcare utilization and improve quality measures related to stroke prevention. Epidemiologically, carotid artery stenosis is prevalent in populations with risk factors such as hypertension, diabetes, and hyperlipidemia, making awareness and management of this condition crucial for public health.

Reimbursement & Billing Impact

Reimbursement considerations include the need for prior authorization for certain imaging studies and procedures. Common denials may arise from insufficient documentation or failure to demonstrate the severity of the condition. Best practices include ensuring that all clinical notes are thorough, specifying the laterality of the condition, and providing clear evidence of the patient's symptoms and treatment plan.

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 I65.22?

I65.22 covers occlusion and stenosis of the left carotid artery, which may be due to atherosclerosis or other vascular diseases. It is important to document the severity of the stenosis and any associated symptoms such as TIAs or strokes.

When should I65.22 be used instead of related codes?

I65.22 should be used when the occlusion or stenosis specifically affects the left carotid artery. If the right carotid artery is involved, I65.21 should be used. Additionally, if both arteries are affected, I65.23 may be appropriate.

What documentation supports I65.22?

Documentation should include clinical findings, imaging results that confirm the diagnosis of left carotid artery stenosis or occlusion, and any relevant patient history, such as previous TIAs or strokes.