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ICD-10 Guide
ICD-10 CodesI63.511

I63.511

Billable

Cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery

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

Code Description

ICD-10 I63.511 is a billable code used to indicate a diagnosis of cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery.

Key Diagnostic Point:

Cerebral infarction due to unspecified occlusion or stenosis of the right middle cerebral artery (MCA) is a critical condition characterized by the interruption of blood flow to the brain tissue supplied by this artery. The MCA is responsible for supplying blood to significant portions of the lateral aspect of the cerebral hemispheres, including areas responsible for motor and sensory functions of the face and upper limbs, as well as language in the dominant hemisphere. Clinical presentation often includes sudden onset of weakness, numbness, or paralysis on one side of the body, difficulty speaking, and visual disturbances. The disease progression can vary, with some patients experiencing transient ischemic attacks (TIAs) before a full-blown stroke occurs. Diagnostic considerations include neuroimaging techniques such as CT or MRI scans to confirm the presence of an infarct and to rule out hemorrhagic stroke. Risk factors for MCA occlusion include hypertension, diabetes, hyperlipidemia, and lifestyle factors such as smoking and sedentary behavior. Early recognition and intervention are crucial to minimize long-term disability and improve outcomes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical assessment to confirm diagnosis.
  • Treatment complexity: May involve acute management with thrombolytics or surgical interventions.
  • Documentation requirements: Detailed clinical notes and imaging results are essential.
  • Coding specificity: Requires precise coding to differentiate from other stroke types.

Audit Risk Factors

  • Common coding errors: Misidentification of the artery involved or incorrect code selection.
  • Documentation gaps: Incomplete clinical notes that do not support the diagnosis.
  • Billing challenges: Potential denials if documentation does not clearly establish medical necessity.

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

Emergency Medicine

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, particularly those affecting the MCA, have significant clinical implications, leading to potential long-term disability and increased healthcare utilization. The population health impact is substantial, as strokes are a leading cause of morbidity and mortality globally. Quality measures focus on timely intervention and rehabilitation, which are critical for improving outcomes and reducing the burden on healthcare systems.

ICD-9 vs ICD-10

Cerebral infarctions, particularly those affecting the MCA, have significant clinical implications, leading to potential long-term disability and increased healthcare utilization. The population health impact is substantial, as strokes are a leading cause of morbidity and mortality globally. Quality measures focus on timely intervention and rehabilitation, which are critical for improving outcomes and reducing the burden on healthcare systems.

Reimbursement & Billing Impact

Reimbursement considerations include the patient's insurance coverage and the specific services rendered. Common denials may arise from insufficient documentation or failure to demonstrate the acute nature of the condition. Best practices include ensuring that all clinical notes are complete and that imaging results are clearly linked to the 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 I63.511?

I63.511 covers cerebral infarctions specifically due to occlusion or stenosis of the right middle cerebral artery, which may arise from various etiologies including thromboembolic events, atherosclerosis, or other vascular conditions.

When should I63.511 be used instead of related codes?

I63.511 should be used when the infarction is specifically due to occlusion or stenosis of the right MCA and when no other specific cause is identified. It is important to differentiate from other codes that may pertain to different arteries or types of strokes.

What documentation supports I63.511?

Documentation should include a comprehensive clinical assessment, imaging results confirming the infarction, and a clear description of the patient's symptoms and risk factors. Detailed notes on the patient's medical history and any interventions performed are also necessary.