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ICD-10 Guide
ICD-10 CodesI63.5

I63.5

Non-billable

Cerebral infarction due to unspecified occlusion or stenosis of cerebral arteries

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

Code Description

ICD-10 I63.5 is a used to indicate a diagnosis of cerebral infarction due to unspecified occlusion or stenosis of cerebral arteries.

Key Diagnostic Point:

Cerebral infarction due to unspecified occlusion or stenosis of cerebral arteries refers to a condition where blood flow to a part of the brain is obstructed, leading to tissue death (infarction) due to lack of oxygen. This code is used when the specific cause of the occlusion or stenosis is not identified. Clinically, patients may present with sudden onset of neurological deficits, which can include weakness, speech difficulties, or visual disturbances, depending on the area of the brain affected. The anatomy involved includes the cerebral arteries, which supply blood to the brain. Disease progression can vary; some patients may recover partially or fully, while others may experience long-term disabilities. Diagnostic considerations include imaging studies such as CT or MRI scans to identify the infarct and rule out other causes of symptoms. Additionally, vascular studies may be necessary to assess for potential underlying conditions contributing to the occlusion or stenosis.

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 infarctions, including those coded as I63.5, have significant clinical implications, affecting patient quality of life and healthcare costs. They are a leading cause of disability and mortality worldwide. Understanding the epidemiology of these conditions helps in developing targeted interventions and improving population health outcomes. Quality measures related to stroke care emphasize timely diagnosis and treatment, which can reduce long-term complications and improve recovery rates.

ICD-9 vs ICD-10

Cerebral infarctions, including those coded as I63.5, have significant clinical implications, affecting patient quality of life and healthcare costs. They are a leading cause of disability and mortality worldwide. Understanding the epidemiology of these conditions helps in developing targeted interventions and improving population health outcomes. Quality measures related to stroke care emphasize timely diagnosis and treatment, which can reduce long-term complications and improve recovery rates.

Reimbursement & Billing Impact

Reimbursement considerations include verifying that the diagnosis aligns with the procedures performed. Common denials may arise from insufficient documentation or lack of clarity regarding the diagnosis. Best practices include maintaining thorough clinical notes, ensuring that all imaging and diagnostic tests are documented, and using the most specific codes available to avoid ambiguity in billing.

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 I63.5?

I63.5 covers cerebral infarctions resulting from unspecified occlusions or stenosis of cerebral arteries, which may include transient ischemic attacks (TIAs) or strokes where the exact cause is not determined.

When should I63.5 be used instead of related codes?

I63.5 should be used when a cerebral infarction is confirmed but the specific occlusion or stenosis cannot be identified. If a specific cause is known, a more specific code should be selected.

What documentation supports I63.5?

Documentation should include clinical notes detailing the patient's symptoms, diagnostic imaging results, and any assessments performed to rule out other conditions. A clear indication of the infarction's nature and the absence of a specified cause is essential.