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ICD-10 Guide
ICD-10 CodesI63.4

I63.4

Non-billable

Cerebral infarction due to embolism of cerebral arteries

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

Code Description

ICD-10 I63.4 is a used to indicate a diagnosis of cerebral infarction due to embolism of cerebral arteries.

Key Diagnostic Point:

Cerebral infarction due to embolism of cerebral arteries is a type of stroke that occurs when a blood clot or other debris travels through the bloodstream and lodges in the cerebral arteries, obstructing blood flow to a part of the brain. This blockage can lead to ischemia and subsequent brain tissue death, resulting in neurological deficits. Clinically, patients may present with sudden onset of symptoms such as weakness, numbness, difficulty speaking, or loss of coordination, depending on the area of the brain affected. The anatomy involved includes the major cerebral arteries, such as the middle cerebral artery, anterior cerebral artery, and posterior cerebral artery. Disease progression can vary; some patients may recover fully, while others may experience long-term disabilities or complications. Diagnostic considerations include neuroimaging studies like CT or MRI to confirm the presence of an infarct and to rule out hemorrhagic stroke. Additionally, risk factors such as atrial fibrillation, carotid artery disease, and hyperlipidemia should be assessed to guide management and prevention strategies.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity
  • Treatment complexity
  • Documentation requirements
  • Coding specificity

Audit Risk Factors

  • Common coding errors
  • Documentation gaps
  • Billing challenges

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 embolism significantly impacts population health, contributing to morbidity and mortality rates associated with stroke. It necessitates comprehensive management strategies to improve patient outcomes and reduce healthcare utilization. Quality measures focus on timely diagnosis and treatment, as well as secondary prevention strategies to mitigate future strokes. Epidemiologically, understanding the prevalence of embolic strokes can guide public health initiatives aimed at reducing risk factors in the population.

ICD-9 vs ICD-10

Cerebral infarction due to embolism significantly impacts population health, contributing to morbidity and mortality rates associated with stroke. It necessitates comprehensive management strategies to improve patient outcomes and reduce healthcare utilization. Quality measures focus on timely diagnosis and treatment, as well as secondary prevention strategies to mitigate future strokes. Epidemiologically, understanding the prevalence of embolic strokes can guide public health initiatives aimed at reducing risk factors in the population.

Reimbursement & Billing Impact

Reimbursement considerations include the patient's insurance coverage and the necessity of imaging studies to confirm the diagnosis. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity. Best practices include ensuring that all clinical findings, imaging results, and treatment plans are clearly documented and aligned with the coding guidelines to minimize audit risks.

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 I63.4?

I63.4 specifically covers cerebral infarctions caused by embolisms originating from various sources, including cardiac emboli from atrial fibrillation or thrombi from other vascular territories. It is crucial to document the source of the embolism for accurate coding.

When should I63.4 be used instead of related codes?

I63.4 should be used when the cerebral infarction is specifically due to an embolism, as opposed to thrombosis or other causes. Accurate differentiation is essential for appropriate treatment and management.

What documentation supports I63.4?

Documentation should include clinical findings, imaging results confirming the infarction, and details regarding the source of the embolism. Additionally, a thorough review of the patient's medical history and risk factors is necessary.