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ICD-10 Guide
ICD-10 CodesI63.111

I63.111

Billable

Cerebral infarction due to embolism of right vertebral artery

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

Code Description

ICD-10 I63.111 is a billable code used to indicate a diagnosis of cerebral infarction due to embolism of right vertebral artery.

Key Diagnostic Point:

Cerebral infarction due to embolism of the right vertebral artery is a critical condition characterized by the obstruction of blood flow to the brain caused by an embolus originating from another site, often the heart or large vessels. The right vertebral artery supplies blood to the posterior circulation of the brain, including the brainstem and cerebellum. Clinical presentation may include sudden onset of neurological deficits such as weakness, speech difficulties, dizziness, and loss of coordination. Disease progression can lead to significant morbidity, including long-term disability or death, if not promptly addressed. Diagnostic considerations involve neuroimaging techniques such as CT or MRI to confirm the presence of an infarct and to rule out other causes of stroke. Additionally, vascular imaging may be necessary to identify the source of the embolism. Early recognition and intervention are crucial to minimize brain damage and improve outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical evaluation to confirm diagnosis.
  • Treatment complexity: May involve anticoagulation, rehabilitation, and management of risk factors.
  • Documentation requirements: Detailed clinical notes and imaging reports are essential.
  • Coding specificity: Requires precise coding to differentiate from other types of strokes.

Audit Risk Factors

  • Common coding errors: Misidentification of the affected artery or type of stroke.
  • Documentation gaps: Incomplete clinical notes or lack of imaging reports.
  • Billing challenges: Potential denials due to 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

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 infarction due to embolism of the right vertebral artery has significant clinical implications, contributing to a high burden of morbidity and mortality. It affects population health by increasing healthcare utilization, including emergency services and rehabilitation. Quality measures focus on timely intervention and management of risk factors to prevent recurrence. Epidemiologically, this condition is prevalent among older adults and those with cardiovascular risk factors, highlighting the need for effective prevention strategies.

ICD-9 vs ICD-10

Cerebral infarction due to embolism of the right vertebral artery has significant clinical implications, contributing to a high burden of morbidity and mortality. It affects population health by increasing healthcare utilization, including emergency services and rehabilitation. Quality measures focus on timely intervention and management of risk factors to prevent recurrence. Epidemiologically, this condition is prevalent among older adults and those with cardiovascular risk factors, highlighting the need for effective prevention strategies.

Reimbursement & Billing Impact

Reimbursement may depend on the severity of the stroke and the complexity of care. Common denials can arise from insufficient documentation or failure to demonstrate medical necessity. It is essential to include all relevant clinical notes, imaging studies, and treatment plans to ensure proper reimbursement. Coders should also be aware of payer-specific guidelines and requirements for stroke management.

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 I63.111?

I63.111 specifically covers cerebral infarction resulting from an embolism in the right vertebral artery. This includes ischemic strokes where the embolus may originate from the heart (e.g., atrial fibrillation) or from atherosclerotic plaques.

When should I63.111 be used instead of related codes?

I63.111 should be used when the stroke is specifically due to embolism in the right vertebral artery. It is important to differentiate this from other stroke types, such as those due to thrombosis or hemorrhage, or embolism in other arteries.

What documentation supports I63.111?

Documentation should include a detailed clinical assessment, imaging results confirming the cerebral infarction, and notes indicating the source of the embolism. Neurological assessments and treatment plans should also be included.