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ICD-10 Guide
ICD-10 CodesI65.0

I65.0

Non-billable

Occlusion and stenosis of vertebral artery

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

Code Description

ICD-10 I65.0 is a used to indicate a diagnosis of occlusion and stenosis of vertebral artery.

Key Diagnostic Point:

I65.0 refers to the occlusion and stenosis of the vertebral artery, which is a critical component of the vertebrobasilar circulation supplying blood to the posterior part of the brain. Clinically, patients may present with symptoms such as dizziness, vertigo, visual disturbances, and in severe cases, posterior circulation strokes. The vertebral arteries arise from the subclavian arteries and ascend through the cervical vertebrae, merging to form the basilar artery. Disease progression can lead to significant ischemic events, particularly in older adults or those with risk factors like hypertension, diabetes, and hyperlipidemia. Diagnostic considerations include imaging studies such as Doppler ultrasound, CT angiography, or MR angiography to assess blood flow and identify stenosis or occlusion. Early detection and management are crucial to prevent complications such as transient ischemic attacks (TIAs) or strokes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical correlation.
  • Treatment complexity: May involve medical management or surgical intervention.
  • Documentation requirements: Detailed clinical history and imaging results needed.
  • Coding specificity: Requires precise coding to differentiate from other vascular conditions.

Audit Risk Factors

  • Common coding errors: Misclassification with other cerebrovascular codes.
  • Documentation gaps: Incomplete clinical history or imaging reports.
  • Billing challenges: Denials due to lack of supporting documentation.

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

Vascular Surgery

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

The clinical significance of I65.0 lies in its potential to lead to serious neurological deficits if not diagnosed and managed appropriately. The population health impact is substantial, particularly among older adults and those with vascular risk factors. Quality measures may include monitoring for timely diagnosis and treatment of vertebral artery occlusion to prevent strokes. Understanding healthcare utilization patterns related to this condition can inform preventive strategies and resource allocation in managing cerebrovascular diseases.

ICD-9 vs ICD-10

The clinical significance of I65.0 lies in its potential to lead to serious neurological deficits if not diagnosed and managed appropriately. The population health impact is substantial, particularly among older adults and those with vascular risk factors. Quality measures may include monitoring for timely diagnosis and treatment of vertebral artery occlusion to prevent strokes. Understanding healthcare utilization patterns related to this condition can inform preventive strategies and resource allocation in managing cerebrovascular diseases.

Reimbursement & Billing Impact

Reimbursement considerations include ensuring that the medical necessity for imaging is clearly documented. Common denials may arise from insufficient documentation or failure to demonstrate the need for the procedure. Best practices include maintaining thorough records of patient evaluations, imaging results, and treatment plans to support claims and reduce the risk of audits.

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 I65.0?

I65.0 covers occlusion and stenosis of the vertebral artery, which may lead to ischemic symptoms and complications such as strokes. It is important to differentiate it from other cerebrovascular conditions.

When should I65.0 be used instead of related codes?

I65.0 should be used when there is a confirmed diagnosis of vertebral artery occlusion or stenosis, particularly when imaging studies support this finding, differentiating it from codes for other vascular territories.

What documentation supports I65.0?

Documentation should include a comprehensive clinical evaluation, imaging results showing occlusion or stenosis of the vertebral artery, and any relevant patient history that supports the diagnosis.