Crystal's MCW Coder Hub🧬 ICD-10 CM I69.054 — Hemiplegia and hemiparesis following nontraumatic subarachnoid hemorrhage affecting left non-dominant side
Billable Code Confirmed
ICD-10 CM I69.054 is a valid, billable 7-character ICD-10-CM code for FY2026. All characters are present. No further specificity is required.
Default Dominance Rule (Left Side)
Per ICD-10-CM Official Coding Guidelines, if a patient has left-sided hemiplegia or hemiparesis and the medical record does not specify their handedness/dominance, the default is to code it as non-dominant1. Therefore, I69.054 is the correct code for left-sided deficits in an ambidextrous person, a known right-handed person, or a person whose handedness is entirely undocumented.
🔍 Code Description
ICD-10 CM I69.054 classifies the late effects (sequelae) of a nontraumatic subarachnoid hemorrhage (SAH) that have resulted in hemiplegia (complete paralysis) or hemiparesis (weakness) on the left, non-dominant side of the body2.
A sequela is a residual condition produced after the acute phase of an illness or injury has terminated. There is no time limit on when a sequela code can be used; it may appear months or years after the initial SAH.
The underlying cause of this specific deficit was a hemorrhage into the subarachnoid space (the area between the arachnoid membrane and the pia mater), typically caused by a ruptured berry aneurysm or arteriovenous malformation (AVM)3.
🌳 Code Tree / Hierarchy
I69 Sequelae of cerebrovascular disease
│
└── I69.0 Sequelae of nontraumatic subarachnoid hemorrhage ❌ Non-billable
│
└── I69.05 Hemiplegia and hemiparesis following SAH ❌ Non-billable
├── I69.051 Right dominant side ✅ Billable
├── I69.052 Left dominant side ✅ Billable
├── I69.053 Right non-dominant side ✅ Billable
├── I69.054 LEFT NON-DOMINANT SIDE ◀ THIS CODE ✅ Billable
└── I69.059 Unspecified side ⚠️ Avoid✅ Includes
The following clinical terms and scenarios map to I69.054:
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Left-sided weakness (non-dominant) due to old SAH.
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Left-sided paralysis (non-dominant) secondary to ruptured brain aneurysm 5 years ago.
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spastic hemiplegia of the left non-dominant side as a late effect of subarachnoid bleeding.
❌ Excludes
Excludes 1 — Cannot Be Coded Simultaneously
| Code | Description | Note |
|---|---|---|
| I60.9 | Nontraumatic subarachnoid hemorrhage, unspecified | Mutually exclusive. Do not code the acute stroke (I60.- family) concurrently with the sequela code (I69.- family) for the same event1. |
| G81.94 1 | Hemiplegia, unspecified affecting left non-dominant side | Category G81 is excluded when the hemiplegia is explicitly documented as a sequela of cerebrovascular disease. The I69 code alone fully captures both the stroke history and the hemiplegia1. |
📋 Clinical Overview
Pathophysiology
Following the acute phase of a subarachnoid hemorrhage, localized cerebral ischemia (often from severe vasospasm) or direct tissue damage can cause irreversible injury to the upper motor neurons in the primary motor cortex or the corticospinal tract. The decussation (crossing) of the corticospinal tract in the medulla oblongata means that a right-hemisphere brain injury results in left-sided motor deficits3.
Clinical Presentation
Patients coded with I69.054 present with:
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Unilateral weakness or paralysis of the left arm, leg, and sometimes the lower left face.
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Usually accompanied by upper motor neuron signs: hypertonia (spasticity), hyperreflexia, and a positive Babinski sign3.
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The patient is typically right-handed (or handedness is unknown), meaning their left side is non-dominant, which often results in less severe functional impairment regarding writing and fine motor tasks compared to dominant-side involvement.
💰 HCC Risk Adjustment (CMS-HCC v28)
| Field | Detail |
|---|---|
| CMS-HCC Model Version | v28 (2024-2026 Implementation) |
| HCC Assignment | HCC 193 |
| HCC Category | Paraplegia and Hemiplegia |
| RAF Coefficient | Subject to demographic variables |
🛠️ CPT & Procedural Crosswalk
While I69.054 is a diagnosis code, it justifies the medical necessity for various therapeutic interventions and evaluations.
| CPT Code | Description | Clinical Application |
|---|---|---|
| 97110 | Therapeutic procedure, 1 or more areas, each 15 minutes | Physical therapy to improve left-sided strength and mobility. |
| 97530 | Therapeutic activities, direct patient contact | Occupational therapy for ADLs utilizing the paretic left arm. |
| 99214 | E/M established patient, moderate complexity | Routine neurology or PM&R follow-up for stroke sequelae. |
| 64640 | Destruction by neurolytic agent; other peripheral nerve | Botox injections for left-sided post-stroke spasticity. |
💊 Coding Scenarios and Examples
Scenario 1 — Outpatient PM&R Follow-Up
Clinical Vignette: A 55-year-old right-handed male follows up in the PM&R clinic. He had a severe ruptured anterior communicating artery aneurysm causing an SAH 2 years ago. He is left with residual left-sided hemiparesis and spasticity. He is here for evaluation of a new left ankle-foot orthosis (AFO).
ICD-10-CM:
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I69.054 — Hemiplegia and hemiparesis following nontraumatic SAH, left non-dominant side (Properly captures the specific stroke type, the deficit, and the laterality/dominance).
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R42 — Dizziness and giddiness (If applicable, or any other specific secondary sequela).
Scenario 2 — Improper Acute vs. Sequela Coding (Correction)
Incorrect Coding: A coder assigns I60.9 (Acute SAH) and G81.94 1 (Left non-dominant hemiplegia) for a patient admitted to an inpatient rehab facility 3 weeks after the initial SAH.
Correction: Once discharged from the acute care setting for the stroke, the acute code I60.9 is invalid. Furthermore, G81.94 1 should not be used when the deficit is a known stroke sequela. The single correct code is I69.054.
⚠️ Coding Pitfalls and Tips
| Pitfall or Tip | |
|---|---|
| ❌ | Do not use acute stroke codes (I60-I67) in the rehab or outpatient setting if the acute phase is over. Use the I69 sequelae category. |
| ❌ | Do not code G81.- (Hemiplegia) alongside I69.05-. The I69 code is a combination code that already includes the hemiplegia. |
| ✅ | Remember the default dominance rule. If the left side is affected and the record is silent on whether the patient is left- or right-handed, you must assign the non-dominant code (I69.054)1. |
| ✅ | Code additional sequelae. If the patient also has aphasia (I69.020) or dysphagia (I69.091) from the same SAH, code them in addition to the hemiplegia. |
📚 Sources
1 CMS/NCHS. ICD-10-CM Official Guidelines for Coding and Reporting. Section I.C.9.d: Cerebrovascular Disease; Sequelae of Cerebrovascular Disease; Dominance/Handedness logic.
2 AAPC & ICD10Data. ICD-10-CM Tabular List of Diseases and Injuries. I69 Category instructions.
3 Ropper AH, Samuels MA, Klein JP. Adams and Victor’s Principles of Neurology. Cerebrovascular diseases and stroke pathophysiology.