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ICD-10 Guide
ICD-10 CodesI63.239

I63.239

Billable

Cerebral infarction due to unspecified occlusion or stenosis of unspecified carotid artery

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

Code Description

ICD-10 I63.239 is a billable code used to indicate a diagnosis of cerebral infarction due to unspecified occlusion or stenosis of unspecified carotid artery.

Key Diagnostic Point:

Cerebral infarction due to unspecified occlusion or stenosis of the unspecified carotid artery refers to a condition where blood flow to a part of the brain is obstructed due to narrowing or blockage in the carotid artery, which is responsible for supplying blood to the brain. Clinically, this may present with sudden onset of neurological deficits, such as weakness, speech difficulties, or visual disturbances, depending on the area of the brain affected. The carotid arteries, located on either side of the neck, can become occluded or stenosed due to atherosclerosis, thrombosis, or embolism. Disease progression can lead to transient ischemic attacks (TIAs) or full-blown strokes, necessitating prompt medical intervention. Diagnostic considerations include imaging studies such as carotid Doppler ultrasound, CT angiography, or MRI to assess blood flow and identify occlusions. Management may involve antiplatelet therapy, anticoagulation, or surgical interventions like carotid endarterectomy, depending on the severity and specifics of the occlusion.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical assessment to confirm diagnosis.
  • Treatment complexity: May involve multiple treatment modalities and specialist referrals.
  • Documentation requirements: Detailed documentation of symptoms, imaging results, and treatment plans is essential.
  • Coding specificity: Requires careful selection to differentiate from other cerebrovascular accident codes.

Audit Risk Factors

  • Common coding errors: Misclassification with other stroke codes.
  • Documentation gaps: Incomplete clinical notes regarding the nature of occlusion.
  • Billing challenges: Potential for denials if documentation does not support the diagnosis.

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

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Cerebral infarction due to carotid artery occlusion significantly impacts population health, contributing to the burden of stroke-related morbidity and mortality. Effective management of this condition is vital for improving quality measures related to stroke care and reducing healthcare utilization patterns associated with acute stroke events. Epidemiologically, understanding the prevalence of carotid artery disease can help in developing preventive strategies and improving patient outcomes.

ICD-9 vs ICD-10

Cerebral infarction due to carotid artery occlusion significantly impacts population health, contributing to the burden of stroke-related morbidity and mortality. Effective management of this condition is vital for improving quality measures related to stroke care and reducing healthcare utilization patterns associated with acute stroke events. Epidemiologically, understanding the prevalence of carotid artery disease can help in developing preventive strategies and improving patient outcomes.

Reimbursement & Billing Impact

reimbursement considerations include the need for prior authorization for imaging studies and potential appeals for denied claims. It is crucial to follow coding best practices, including accurate coding of associated conditions and ensuring that the medical necessity is clearly established in the documentation.

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 I63.239?

I63.239 encompasses cerebral infarctions resulting from unspecified occlusions or stenosis of the carotid artery, which may include conditions like atherosclerotic disease or embolic strokes where the source of the occlusion is not clearly defined.

When should I63.239 be used instead of related codes?

I63.239 should be used when the occlusion or stenosis of the carotid artery is not specified, and there is no clear indication of which artery is affected, differentiating it from codes that specify right or left carotid artery involvement.

What documentation supports I63.239?

Documentation should include clinical notes detailing the patient's symptoms, results from imaging studies that indicate occlusion or stenosis, and any relevant history of cardiovascular disease or risk factors.