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ICD-10 Guide
ICD-10 CodesI63.12

I63.12

Billable

Cerebral infarction due to embolism of basilar artery

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

Code Description

ICD-10 I63.12 is a billable code used to indicate a diagnosis of cerebral infarction due to embolism of basilar artery.

Key Diagnostic Point:

Cerebral infarction due to embolism of the basilar artery is a critical condition characterized by the obstruction of blood flow to the brain, specifically affecting the basilar artery, which supplies blood to the brainstem and cerebellum. This condition often presents with sudden onset of neurological deficits, including dizziness, visual disturbances, ataxia, and altered consciousness, depending on the area of the brain affected. The anatomy involved includes the vertebrobasilar system, where emboli can originate from various sources, such as the heart (in cases of atrial fibrillation), large vessel disease, or even from atherosclerotic plaques. Disease progression can lead to significant morbidity, including permanent neurological deficits or death if not promptly treated. Diagnostic considerations include neuroimaging studies such as CT or MRI to confirm the presence of an infarct and to rule out hemorrhagic stroke. Additionally, vascular imaging may be necessary to identify the source of the embolism and assess for underlying vascular disease.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical evaluation to confirm diagnosis.
  • Treatment complexity: May involve acute management with thrombolytics or anticoagulants, followed by rehabilitation.
  • Documentation requirements: Detailed documentation of clinical findings, imaging results, and treatment plans is essential.
  • Coding specificity: Requires precise coding to differentiate from other types of strokes.

Audit Risk Factors

  • Common coding errors: Misclassification of stroke type or failure to document embolic source.
  • Documentation gaps: Incomplete clinical notes regarding patient history or imaging findings.
  • Billing challenges: Potential denials due to insufficient documentation supporting the acute nature of the condition.

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 embolism of the basilar artery has significant clinical implications, as it can lead to severe disability or death. Understanding the epidemiology of this condition is crucial, as it affects a substantial portion of the population, particularly older adults and those with cardiovascular risk factors. Quality measures related to timely diagnosis and treatment can improve patient outcomes and reduce healthcare utilization, emphasizing the importance of effective coding and documentation.

ICD-9 vs ICD-10

Cerebral infarction due to embolism of the basilar artery has significant clinical implications, as it can lead to severe disability or death. Understanding the epidemiology of this condition is crucial, as it affects a substantial portion of the population, particularly older adults and those with cardiovascular risk factors. Quality measures related to timely diagnosis and treatment can improve patient outcomes and reduce healthcare utilization, emphasizing the importance of effective coding and documentation.

Reimbursement & Billing Impact

Reimbursement considerations include the need for clear evidence of the acute nature of the stroke and the embolic source. Common denials may arise from insufficient documentation or failure to provide evidence of medical necessity for imaging and treatment. Best practices include ensuring that all clinical notes are complete and that the coding accurately reflects the diagnosis and treatment provided.

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 I63.12?

I63.12 specifically covers cerebral infarction resulting from an embolism in the basilar artery. This can include emboli from cardiac sources, such as atrial fibrillation, or from other vascular conditions. It is crucial to document the source of the embolism for accurate coding.

When should I63.12 be used instead of related codes?

I63.12 should be used when the cerebral infarction is specifically due to an embolism in the basilar artery, as opposed to thrombosis or other types of strokes. Accurate differentiation is essential for appropriate treatment and reimbursement.

What documentation supports I63.12?

Documentation should include clinical findings, imaging results confirming the cerebral infarction, and notes on the source of the embolism. Detailed accounts of the patient's symptoms and treatment plan are also necessary to support the diagnosis.