Crystal's MCW Coder Hub🧬 ICD-10 CM I69.254 — Hemiplegia and hemiparesis following other nontraumatic intracranial hemorrhage affecting left non-dominant side
Billable Code Confirmed
ICD-10 CM I69.254 is a valid, billable 7-character ICD-10-CM code for FY2026. All characters are present. No further specificity is required.
"Other" Intracranial Hemorrhage Distinctions
The subcategory I69.2 is explicitly for sequelae of other nontraumatic intracranial hemorrhages (such as subdural or extradural/epidural hemorrhages)1.
- If the underlying cause was a subarachnoid hemorrhage, use I69.054.
- If the underlying cause was an intracerebral hemorrhage (bleeding directly inside the brain parenchyma), use I69.154.
🔍 Code Description
ICD-10 CM I69.254 classifies the late effects of a nontraumatic intracranial hemorrhage (specifically those falling under category I62, such as nontraumatic subdural or epidural bleeds) resulting in hemiplegia or hemiparesis on the left, non-dominant side1.
This combination code captures both the etiology (historical “other” intracranial bleed) and the current manifestation (unilateral left-sided weakness/paralysis). The left side is classified as non-dominant either because the patient is documented as right-handed, or because handedness is completely undocumented, invoking the ICD-10 default rule for left-sided deficits2.
🌳 Code Tree / Hierarchy
I69 Sequelae of cerebrovascular disease
│
└── I69.2 Sequelae of other nontraumatic intracranial hemorrhage ❌ Non-billable
│
└── I69.25 Hemiplegia and hemiparesis following other ICH ❌ Non-billable
├── I69.251 Right dominant side ✅ Billable
├── I69.252 Left dominant side ✅ Billable
├── I69.253 Right non-dominant side ✅ Billable
├── I69.254 LEFT NON-DOMINANT SIDE ◀ THIS CODE ✅ Billable
└── I69.259 Unspecified side ⚠️ Avoid✅ Includes
The following clinical terms and scenarios map to I69.254:
-
Left-sided hemiplegia secondary to an old nontraumatic subdural hematoma.
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Left arm and leg weakness following a previous spontaneous extradural hemorrhage.
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Hemiparesis of the left non-dominant side due to unspecified prior intracranial hemorrhage (not specified as subarachnoid or intracerebral).
❌ Excludes
Excludes 1 — Cannot Be Coded Simultaneously
| Code | Description | Note |
|---|---|---|
| I62.9 | Nontraumatic intracranial hemorrhage, unspecified | Mutually exclusive. Do not code the acute phase bleed simultaneously with the late-effect sequela code2. |
| I69.154 | Hemiplegia/hemiparesis following nontraumatic intracerebral hemorrhage | Mutually exclusive. Distinguish between intracerebral (inside brain tissue) and “other” (subdural/epidural) bleeds. |
📋 Clinical Overview
Pathophysiology
“Other” intracranial hemorrhages primarily involve bleeding in the spaces between the skull and the brain (e.g., subdural space between dura and arachnoid, or epidural space between skull and dura). While not bleeding into the brain tissue itself, the expanding hematoma compresses the underlying cerebral cortex. If this pressure causes ischemia or infarction of the right hemisphere’s motor strip before surgical evacuation occurs, the patient will be left with persistent left-sided hemiparesis3.
Clinical Presentation
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Hemiparetic gait involving the left leg.
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Left upper extremity held in a flexed, spastic posture.
-
Because the left hemisphere is typically dominant for language, a right hemisphere injury causing left hemiplegia usually leaves the patient’s speech intact, though they may suffer from right hemisphere syndromes like left-sided hemispatial neglect.
💰 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
| CPT Code | Description | Clinical Application |
|---|---|---|
| 99214 | E/M established patient, moderate complexity | Routine management of chronic stroke sequelae. |
| 97161 | Physical therapy evaluation: low complexity | Baseline functional assessment for AFOs or mobility aids. |
| 97112 | Therapeutic procedure, neuromuscular reeducation | Balance and coordination training for hemiparetic gait. |
💊 Coding Scenarios and Examples
Scenario 1 — Long-Term Care Assessment
Clinical Vignette: A 78-year-old female resident in a skilled nursing facility is being evaluated by the physician. Three years ago, she suffered a spontaneous (nontraumatic) right-sided subdural hematoma requiring emergency burr hole evacuation. She has permanent weakness of her left arm and leg. She is right-handed.
ICD-10-CM:
- I69.254 — Hemiplegia and hemiparesis following other nontraumatic intracranial hemorrhage, left non-dominant side (Subdural hemorrhage falls under “other” intracranial hemorrhages [I62]. Left side in a right-handed patient is non-dominant).
Scenario 2 — Conflicting Documentation Resolution
Clinical Vignette: A provider writes: “Patient has left hemiplegia from a prior stroke. History indicates it was a bleed, exact location unknown.”
Coding Action: Because the exact location of the bleed (subarachnoid vs. intracerebral vs. other) is undocumented, standard coding guidelines default to unspecified cerebrovascular disease. However, if looking closely at the medical record uncovers a discharge summary stating “nontraumatic subdural hemorrhage,” the coder should select I69.254. If it truly cannot be determined, I69.954 (Sequelae of unspecified cerebrovascular disease) is the fallback.
⚠️ Coding Pitfalls and Tips
| Pitfall or Tip | |
|---|---|
| ❌ | Do not confuse traumatic vs. nontraumatic. The I69 family is strictly for nontraumatic (spontaneous) cerebrovascular diseases. If the subdural hematoma was caused by a fall or car accident, you must use traumatic brain injury sequelae codes (e.g., S06.- with an ‘S’ 7th character), not I69.254 |
| ✅ | Pay attention to the exact cerebrovascular anatomy. Subarachnoid (I69.0), Intracerebral (I69.1), and Other Intracranial (I69.2) are distinct. “Other” generally means subdural or epidural bleeds. |
| ✅ | Use the Left = Non-Dominant rule. If the chart only says “Left hemiplegia due to old subdural bleed” without mentioning handedness, assign I69.254 (non-dominant) per standard ICD-10 guidelines2. |
📚 Sources
1 AAPC & ICD10Data. ICD-10-CM Tabular List of Diseases and Injuries. I69.2 Category mapping.
2 CMS/NCHS. ICD-10-CM Official Guidelines for Coding and Reporting. Chapter 9, Cerebrovascular Disease; Sequelae/Late Effects rules; Traumatic vs. Nontraumatic definitions.
3 Ropper AH, Samuels MA, Klein JP. Adams and Victor’s Principles of Neurology. Pathophysiology of subdural and epidural hemorrhages and motor cortex compression.