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ICD-10 Guide
ICD-10 CodesI65.21

I65.21

Billable

Occlusion and stenosis of right carotid artery

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

Code Description

ICD-10 I65.21 is a billable code used to indicate a diagnosis of occlusion and stenosis of right carotid artery.

Key Diagnostic Point:

I65.21 refers to the occlusion and stenosis of the right carotid artery, a condition characterized by the narrowing or blockage of the artery that supplies blood to the brain. This condition can lead to significant clinical presentations, including transient ischemic attacks (TIAs) or strokes, which may manifest as sudden weakness, speech difficulties, or visual disturbances. The right carotid artery, branching from the aorta, bifurcates into the internal and external carotid arteries, supplying blood to the brain and face. Disease progression often involves atherosclerosis, where fatty deposits build up in the arterial walls, leading to reduced blood flow. Diagnostic considerations include imaging studies such as carotid Doppler ultrasound, CT angiography, or MR angiography to assess the degree of stenosis. Early detection and management are crucial to prevent serious complications such as cerebrovascular accidents. Treatment may involve lifestyle modifications, medication, or surgical interventions like carotid endarterectomy or stenting, depending on the severity of the occlusion.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires imaging and clinical evaluation to confirm diagnosis.
  • Treatment complexity: May involve medical management or surgical intervention.
  • Documentation requirements: Detailed clinical documentation is necessary to justify the diagnosis and treatment.
  • Coding specificity: Requires precise coding to differentiate from other carotid artery conditions.

Audit Risk Factors

  • Common coding errors: Misidentification of the side of occlusion or stenosis.
  • Documentation gaps: Incomplete clinical notes or lack of imaging reports.
  • Billing challenges: Denials may occur if documentation does not support the severity of the condition.

Specialty Focus

Medical Specialties

Primary medical specialty: 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

Secondary specialty: 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

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 I65.21 lies in its potential to lead to serious cerebrovascular events, impacting patient morbidity and mortality. Understanding the epidemiology of carotid artery disease is crucial, as it affects a substantial portion of the aging population, contributing to healthcare utilization patterns. Quality measures focusing on early detection and management of carotid artery occlusion can improve patient outcomes and reduce the burden on healthcare systems.

ICD-9 vs ICD-10

The clinical significance of I65.21 lies in its potential to lead to serious cerebrovascular events, impacting patient morbidity and mortality. Understanding the epidemiology of carotid artery disease is crucial, as it affects a substantial portion of the aging population, contributing to healthcare utilization patterns. Quality measures focusing on early detection and management of carotid artery occlusion can improve patient outcomes and reduce the burden on healthcare systems.

Reimbursement & Billing Impact

Reimbursement considerations include the severity of the condition and the necessity of interventions. Common denials may arise from insufficient documentation or failure to demonstrate medical necessity for procedures. Coders should ensure that all relevant clinical information is included in the medical record to facilitate accurate billing and minimize audit risks. Best practices include regular training on coding updates and thorough reviews of documentation before submission.

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 I65.21?

I65.21 covers occlusion and stenosis of the right carotid artery, which may result from atherosclerosis, thrombosis, or embolism. It is important to document the degree of stenosis and any associated symptoms, such as TIAs or strokes.

When should I65.21 be used instead of related codes?

I65.21 should be used specifically when there is documented occlusion or stenosis of the right carotid artery. If the condition affects the left carotid artery, I65.22 should be used. Additionally, if there are symptoms of cerebrovascular events, appropriate codes for those conditions should also be considered.

What documentation supports I65.21?

Documentation supporting I65.21 should include clinical notes detailing the patient's symptoms, results from imaging studies confirming the occlusion or stenosis, and any treatment plans. It is essential to have a clear record of the patient's history and risk factors for cardiovascular disease.