ICDcodes.org
FY2027

I69.859 — Hemiplegia and hemiparesis following other cerebrovascular disease affecting unspecified side

BillableUnspecifiedCC

Is I69.859 billable?

Yes, but I69.859 will trip a Medicare edit. I69.859 is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, CMS lists I69.859 under Medicare Code Editor edit 20, “Unspecified code” — meaning a code specifying laterality (right, left or bilateral) exists in the same family. On an inpatient claim this triggers the edit, because CMS holds that there are very limited circumstances in which laterality cannot be documented.

I69.859 at a glance

CodeI69.859
DescriptionHemiplegia and hemiparesis following other cerebrovascular disease affecting unspecified side
BillableYes
Code setICD-10-CM FY2027
Valid for encountersOctober 1, 2026 – September 30, 2027

What Medicare edits apply to I69.859?

The Medicare Code Editor screens inpatient claims before they are grouped. These edits name I69.859 directly.

Unspecified — a laterality-specific code exists — MCE edit 20

A code specifying laterality (right, left or bilateral) exists in the same family. CMS holds that there are very limited circumstances in which laterality cannot be documented.

Which MS-DRGs does I69.859 group to?

I69.859 sits in MDC 01 and helps define the logic of 2 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.

  • 056Degenerative Nervous System Disorders with MCCmedical
  • 057Degenerative Nervous System Disorders without MCCmedical

As a secondary diagnosis, I69.859 is a complication or comorbidity (CC), which can move a stay into a higher-paying DRG.

How is I69.859 listed in the Alphabetic Index?

The Alphabetic Index lists these routes under I69.85, the nearest indexed parent of I69.859. Use them to find the family, then select the specific code.

  • Hemiplegia › following › cerebrovascular disease › specified disease NEC
  • Sequelae › disease › cerebrovascular › specified type NEC › hemiplegia (of)

Excludes1 — never code together — inherited from I60-I69

The conditions below can never be reported together with I69.859 on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.

  • traumatic intracranial hemorrhage (S06.-)

Excludes1 — never code together — inherited from I69

The conditions below can never be reported together with I69.859 on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.

  • personal history of cerebral infarction without residual deficit (Z86.73)
  • personal history of prolonged reversible ischemic neurologic deficit (PRIND) (Z86.73)
  • personal history of reversible ischemic neurologcial deficit (RIND) (Z86.73)
  • sequelae of traumatic intracranial injury (S06.-)

Excludes1 — never code together — inherited from I69.8

The conditions below can never be reported together with I69.859 on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.

  • sequelae of traumatic intracranial injury (S06.-)

Use additional code — inherited from I60-I69

Report an additional code alongside I69.859 to fully describe the condition. I69.859 is sequenced first.

  • code to identify presence of:
  • alcohol abuse and dependence (F10.-)
  • exposure to environmental tobacco smoke (Z77.22)
  • history of tobacco dependence (Z87.891)
  • hypertension (I10-I1A)
  • occupational exposure to environmental tobacco smoke (Z57.31)
  • tobacco dependence (F17.-)
  • tobacco use (Z72.0)

Excludes2 — not included here — inherited from Chapter 9

The conditions below are not part of I69.859, but a patient may have both at the same time. When documentation supports it, I69.859 and the excluded code may both be reported.

  • certain conditions originating in the perinatal period (P04-P96)
  • certain infectious and parasitic diseases (A00-B99)
  • complications of pregnancy, childbirth and the puerperium (O00-O9A)
  • congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
  • endocrine, nutritional and metabolic diseases (E00-E88)
  • injury, poisoning and certain other consequences of external causes (S00-T88)
  • neoplasms (C00-D49)
  • symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
  • systemic connective tissue disorders (M30-M36)
  • transient cerebral ischemic attacks and related syndromes (G45.-)

How long has I69.859 existed?

I69.859 has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.

Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.

What other codes are in the I69.85 family? (4)