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ICD-10 Guide
ICD-10 CodesI63.43

I63.43

Non-billable

Cerebral infarction due to embolism of posterior cerebral artery

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

Code Description

ICD-10 I63.43 is a used to indicate a diagnosis of cerebral infarction due to embolism of posterior cerebral artery.

Key Diagnostic Point:

Cerebral infarction due to embolism of the posterior cerebral artery (PCA) is a critical condition characterized by the obstruction of blood flow to the PCA, leading to ischemic damage in the brain. The PCA supplies blood to the occipital lobe, inferior temporal lobe, and various deep structures, including the thalamus. Clinical presentation often includes visual disturbances, such as homonymous hemianopia, and cognitive deficits, depending on the extent of the infarction. The disease progression can vary; some patients may experience rapid onset of symptoms, while others may have a more gradual decline. Diagnostic considerations include neuroimaging techniques such as CT or MRI scans to confirm the presence of an infarct and to rule out hemorrhagic stroke. Additionally, vascular imaging may be performed to identify the source of the embolism, which could be cardiac in origin or due to atherosclerotic disease. Timely diagnosis and intervention are crucial to minimize neurological deficits and improve patient outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical correlation.
  • Treatment complexity: May involve anticoagulation, rehabilitation, and monitoring.
  • Documentation requirements: Detailed clinical notes and imaging results are essential.
  • Coding specificity: Requires precise identification of the embolic source and affected artery.

Audit Risk Factors

  • Common coding errors: Misidentifying the type of stroke or artery involved.
  • Documentation gaps: Incomplete clinical notes or lack of imaging results.
  • Billing challenges: Denials may occur 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

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

Cerebral infarction due to embolism of the PCA has significant clinical implications, affecting patient quality of life and healthcare utilization. It is a leading cause of morbidity and mortality in the population, necessitating effective management strategies. Understanding the epidemiology of this condition can help healthcare providers implement preventive measures and improve outcomes through timely interventions and rehabilitation services.

ICD-9 vs ICD-10

Cerebral infarction due to embolism of the PCA has significant clinical implications, affecting patient quality of life and healthcare utilization. It is a leading cause of morbidity and mortality in the population, necessitating effective management strategies. Understanding the epidemiology of this condition can help healthcare providers implement preventive measures and improve outcomes through timely interventions and rehabilitation services.

Reimbursement & Billing Impact

Reimbursement considerations include the need for accurate coding to reflect the complexity of the condition. Common denials may arise from insufficient documentation or incorrect coding. Best practices include regular audits of clinical documentation and coding accuracy to prevent denials and ensure proper reimbursement.

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 I63.43?

I63.43 specifically covers cerebral infarctions resulting from embolism affecting the posterior cerebral artery. This includes emboli from cardiac sources, such as atrial fibrillation, or from other vascular conditions.

When should I63.43 be used instead of related codes?

I63.43 should be used when the cerebral infarction is confirmed to be due to an embolism affecting the PCA. If the infarction is due to thrombosis or affects a different artery, other codes such as I63.41 or I63.42 should be considered.

What documentation supports I63.43?

Documentation must include clinical findings, imaging results confirming the infarction, and evidence of the embolic source. Detailed notes on the patient's history, neurological examination, and treatment plan are also necessary.