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ICD-10 Guide
ICD-10 CodesI63.40

I63.40

Billable

Cerebral infarction due to embolism of unspecified cerebral artery

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

Code Description

ICD-10 I63.40 is a billable code used to indicate a diagnosis of cerebral infarction due to embolism of unspecified cerebral artery.

Key Diagnostic Point:

Cerebral infarction due to embolism of an unspecified cerebral artery occurs when a blood clot or other debris travels through the bloodstream and lodges in one of the arteries supplying blood to the brain, leading to a blockage. This interruption in blood flow can cause brain tissue to become ischemic, resulting in cell death and 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 cerebral arteries, which branch from the internal carotid and vertebral arteries. Disease progression can vary; some patients may experience transient ischemic attacks (TIAs) before a full-blown stroke, while others may have a sudden and severe onset. Diagnostic considerations include neuroimaging (CT or MRI) to confirm the presence of an infarct and to rule out hemorrhagic stroke. Additional tests may include echocardiography or vascular imaging to identify the source of the embolism.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical assessment to confirm diagnosis.
  • Treatment complexity: Management may involve anticoagulation, rehabilitation, and monitoring.
  • Documentation requirements: Must document clinical findings, imaging results, and treatment plans.
  • Coding specificity: Requires precise coding to differentiate from other types of strokes.

Audit Risk Factors

  • Common coding errors: Misidentifying the type of stroke or embolic source.
  • Documentation gaps: Incomplete clinical notes or lack of imaging results.
  • Billing challenges: Potential denials if the 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

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 is a leading cause of long-term disability, affecting healthcare utilization patterns as patients often require extensive rehabilitation and follow-up care. Quality measures focus on timely diagnosis and treatment to minimize neurological damage, and epidemiological studies highlight the importance of managing risk factors such as hypertension and atrial fibrillation to reduce incidence.

ICD-9 vs ICD-10

Cerebral infarction due to embolism significantly impacts population health, contributing to morbidity and mortality rates associated with stroke. It is a leading cause of long-term disability, affecting healthcare utilization patterns as patients often require extensive rehabilitation and follow-up care. Quality measures focus on timely diagnosis and treatment to minimize neurological damage, and epidemiological studies highlight the importance of managing risk factors such as hypertension and atrial fibrillation to reduce incidence.

Reimbursement & Billing Impact

Reimbursement considerations include the patient's insurance policy and whether the services provided are deemed medically necessary. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for imaging or treatment. Coding best practices suggest using the most specific code available and ensuring that all related services are linked to the primary diagnosis.

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 I63.40?

I63.40 covers cerebral infarctions specifically due to embolism from an unspecified source. This includes cases where the embolism may originate from the heart or other vascular structures but is not clearly identified.

When should I63.40 be used instead of related codes?

I63.40 should be used when the cerebral infarction is confirmed to be due to embolism and the specific artery involved is not documented. If the artery is specified or if the infarction is due to thrombosis, other codes should be considered.

What documentation supports I63.40?

Documentation should include clinical findings of stroke symptoms, results from neuroimaging that confirm cerebral infarction, and any relevant history that may indicate embolic sources, such as atrial fibrillation.