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I69.320

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🧠 ICD-10-CM I69.320 — Aphasia Following Cerebral Infarction

Billable Code Confirmed

ICD-10-CM I69.320 is a valid, billable 7-character ICD-10-CM diagnosis code for FY2026. Characters 1-3 (I69) identify the category as sequelae of cerebrovascular disease; characters 4-5 (.32) specify speech and language deficits following cerebral infarction; character 6 (0) identifies aphasia as the specific speech/language deficit type. All 7 characters are required — no additional extension characters are needed or applicable.

Non-Billable Parent Codes — Never Submit These

  • ❌ I69 — 3-character category header — does not specify the type of sequela, the originating cerebrovascular event, or the specific deficit
  • ❌ I69.3 — 5-character subcategory — does not specify which sequela type (cognitive, speech, motor, etc.)
  • ❌ I69.32 — 6-character subcategory — does not specify the type of speech/language deficit (aphasia vs. dysarthria vs. dysphasia, etc.)

Always submit I69.320 (all 7 characters) when aphasia is documented as a residual deficit following a confirmed prior cerebral infarction.

Clinical Context: I69.320 vs. R47.01 — Etiology-Driven Code Selection

ICD-10-CM I69.320 captures aphasia only when the provider has explicitly documented that the aphasia is causally linked to a prior cerebral infarction (stroke). When aphasia is documented without a confirmed stroke etiology — or during an initial encounter before workup is complete — use R47.01 (Aphasia, NOS) instead. Never substitute R47.01 for I69.320 when stroke-related aphasia is established in the record; doing so loses the HCC capture and misrepresents the clinical picture.

Code Classification

ICD-10-CM Diagnosis Code — This is a sequela (late effect) code under ICD-10-CM Chapter 9. wRVU, assistant-at-surgery payable, and global period fields are not applicable to diagnosis codes. For associated procedural coding, refer to the CPT Procedural Crosswalk section (SLP evaluation and treatment codes) and the ICD-10-PCS Crosswalk section (inpatient rehabilitation coding).

🔍 Code Description

ICD-10-CM I69.320 classifies aphasia following cerebral infarction — the loss or severe impairment of language ability (speaking, understanding, reading, and/or writing) that persists as a residual neurological deficit after an ischemic stroke. This code is assigned at any point after the acute stroke encounter when the aphasia is documented as an ongoing sequela, regardless of how much time has passed since the originating cerebrovascular event.

Aphasia results from damage to the dominant hemisphere’s language centers — most commonly Broca’s area (expressive language, frontal lobe), Wernicke’s area (receptive language, temporal lobe), or the arcuate fasciculus connecting them. The specific aphasia phenotype (expressive, receptive, global, conduction, anomic) is not captured at the 7th-character level in ICD-10-CM; all subtypes map to I69.320 when the etiology is cerebral infarction. For TBI-related aphasia, see S06.- sequela coding; for aphasia from neurodegenerative disease, use the underlying condition code with R47.01 as an additional code if appropriate.

🌳 Code Tree / Hierarchy

I69   Sequelae of cerebrovascular disease ❌ Non-billable
│
├── I69.0   Sequelae of nontraumatic subarachnoid hemorrhage ❌ Non-billable
├── I69.1   Sequelae of nontraumatic intracerebral hemorrhage ❌ Non-billable
├── I69.2   Sequelae of other nontraumatic intracranial hemorrhage ❌ Non-billable
│
├── I69.3   Sequelae of cerebral infarction ❌ Non-billable
│   │
│   ├── I69.30  Unspecified sequelae of cerebral infarction ✅ Billable
│   │
│   ├── I69.31  Cognitive deficits following cerebral infarction ❌ Non-billable
│   │   ├── I69.310  Attention and concentration deficit following CI ✅ Billable
│   │   ├── I69.311  Memory deficit following CI ✅ Billable
│   │   ├── I69.312  Visuospatial deficit and spatial neglect following CI ✅ Billable
│   │   ├── I69.313  Psychomotor deficit following CI ✅ Billable
│   │   ├── I69.314  Frontal lobe and executive function deficit following CI ✅ Billable
│   │   ├── I69.315  Cognitive social or emotional deficit following CI ✅ Billable
│   │   ├── I69.318  Other symptoms involving cognitive functions following CI ✅ Billable
│   │   └── I69.319  Unspecified symptoms involving cognitive functions following CI ✅ Billable
│   │
│   ├── I69.32  Speech and language deficits following cerebral infarction ❌ Non-billable
│   │   ├── ▶▶ I69.320 ◀◀  Aphasia following cerebral infarction  ← YOU ARE HERE ✅ Billable
│   │   ├── I69.321  Dysphasia following cerebral infarction ✅ Billable
│   │   ├── I69.322  Dysarthria following cerebral infarction ✅ Billable
│   │   ├── I69.323  Fluency disorder following cerebral infarction ✅ Billable
│   │   └── I69.328  Other speech and language deficits following CI ✅ Billable
│   │
│   ├── I69.33  Monoplegia of upper limb following cerebral infarction ❌ Non-billable
│   ├── I69.34  Monoplegia of lower limb following cerebral infarction ❌ Non-billable
│   ├── I69.35  Hemiplegia and hemiparesis following cerebral infarction ❌ Non-billable
│   └── I69.39  Other sequelae of cerebral infarction ❌ Non-billable
│
└── I69.8   Sequelae of other cerebrovascular diseases ❌ Non-billable

Aphasia vs. Dysphasia — They Are Not Interchangeable in ICD-10-CM

I69.320 (Aphasia) and I69.321 (Dysphasia) are distinct codes: aphasia is a complete or near-complete loss of language function, while dysphasia is a partial impairment in language production or comprehension. When provider documentation uses “aphasia,” assign I69.320; when documentation says “dysphasia” or “partial aphasia,” assign I69.321. Do not use I69.320 for dysarthria (I69.322) — which is a motor speech disorder of articulation, not a language processing deficit. Query the provider when documentation is ambiguous between these terms.

✅ Includes

The following clinical terms and scenarios map to I69.320 when documented as sequelae of cerebral infarction:

  • Aphasia due to prior CVA / post-stroke aphasia
  • Expressive aphasia (Broca’s aphasia) following stroke
  • Receptive aphasia (Wernicke’s aphasia) following stroke
  • Global aphasia following cerebral infarction
  • Mixed aphasia following ischemic stroke
  • Anomic aphasia following cerebral infarction
  • Conduction aphasia following cerebral infarction

❌ Excludes

Excludes 1 — Cannot Be Coded Simultaneously with I69.320

CodeDescriptionNote
Z86.73Personal history of cerebral infarction without residual deficitMutually exclusive — Z86.73 indicates the stroke resolved with no persistent deficits; if aphasia is present, residual deficit exists and Z86.73 is incorrect; use I69.320 instead
S06.-Sequelae of traumatic intracranial injuryTBI-related aphasia codes under the injury chapter (S06.-) — never combine with I69.320; the etiology (trauma vs. infarction) determines the code family

Excludes 1 Violation Risk

The most common Excludes 1 error is assigning Z86.73 (personal history of stroke without residual deficit) on the same claim as I69.320 — these are clinically contradictory. If the patient has aphasia, a residual deficit is present and Z86.73 is factually incorrect. Assign I69.320 alone to document both the history of stroke and the ongoing residual deficit; Z86.73 is reserved for patients whose stroke has completely resolved.

Excludes 2 — May Be Coded in Addition if Separately Present

CodeDescriptionNote
R47.01Aphasia, NOSR47.01 is a symptom code; it should not be assigned simultaneously with I69.320 for the same aphasia — they describe the same condition at different specificity levels; use I69.320 as the more specific code when stroke etiology is established

📋 Clinical Overview

The I69.32x subcategory captures five distinct speech and language deficit types following cerebral infarction. Code selection is driven entirely by the provider’s documented terminology and clinical diagnosis — not the coder’s interpretation of symptom severity.

FeatureI69.320 — AphasiaI69.321 — DysphasiaI69.322 — Dysarthria
Core DeficitLanguage processing — loss/severe impairment of comprehension and/or expressionPartial language impairment — reduced but not absent language functionMotor speech — articulation, phonation, prosody impaired; language intact
Brain Region AffectedCortical language centers (Broca’s, Wernicke’s, arcuate fasciculus)Cortical language centers (partial involvement)Motor cortex, cerebellum, brainstem motor pathways
Patient PresentationCannot communicate effectively in spoken or written form; may be mute or severely limitedDifficulty finding words, reduced fluency, or comprehension gapsSlurred, slow, or imprecise speech; language formulation is normal
SLP FocusLanguage restoration, AAC devices, communication compensationLanguage therapy, word retrieval strategiesOral motor exercises, articulation, dysarthria treatment
Documentation TriggerProvider writes “aphasia,” “global aphasia,” “expressive aphasia,” “receptive aphasia”Provider writes “dysphasia,” “partial aphasia,” “word-finding difficulty”Provider writes “dysarthria,” “slurred speech due to stroke,” “motor speech disorder”

CDI Query Trigger — Aphasia Subtype Documentation

When provider documentation uses vague language such as “speech problems post-stroke,” “communication difficulties,” or “difficulty speaking,” a CDI query is appropriate before assigning any I69.32x code. Ask the provider to clarify whether the deficit is aphasia (language), dysphasia, dysarthria (motor speech), or another specific type. The distinction impacts SLP treatment planning, medical necessity support, and HCC capture accuracy.

Manifestations & Symptom Burden

Post-stroke aphasia is rarely isolated — document all concurrent sequelae to fully capture clinical complexity and support DRG optimization:

  • Expressive aphasia (Broca’s): Non-fluent speech, word-finding deficits, preserved comprehension; frustration and psychosocial impact common — consider F06.31 (depressive disorder due to known physiological condition)
  • Receptive aphasia (Wernicke’s): Fluent but paraphasic speech, impaired comprehension; patient often unaware of deficit — documentation of comprehension testing critical
  • Global aphasia: Both expression and comprehension severely affected; commonly associated with significant hemiplegia (I69.351/I69.352) and dysphagia (I69.391)
  • Associated cognitive deficits: Frequently co-occur with I69.31x codes (memory, attention, executive function deficits following CI)
  • Dysphagia following CI: I69.391 — separately billable and separately documentable when present; do not assume dysphagia from aphasia documentation

Coding Manifestations

Always code all documented sequelae of the c**erebral infarction** to fully capture the patient’s complexity. Examples:

  • I69.351 — Hemiplegia following CI, right dominant side
  • I69.391 — Other sequelae of CI (includes dysphagia — query provider for specificity)
  • I69.310 — Attention and concentration deficit following CI
  • F06.31 — Depressive disorder due to known physiological condition (post-stroke depression)

💰 HCC Risk Adjustment (CMS-HCC v28)

FieldDetail
CMS-HCC Model Versionv28 (Fully operative — Payment Year 2026)
HCC Assignment✅ Mapped — HCC 100
HCC CategoryHCC 100 — Ischemic or Unspecified Stroke
RAF Coefficient~0.273 (community, non-dual, aged — verify against CMS v28 factor tables)

I69.320 maps directly to HCC 100 (Ischemic or Unspecified Stroke) under CMS-HCC v28 and contributes meaningfully to the RAF score for Medicare Advantage patients. This HCC signals a history of ischemic stroke with ongoing neurological sequelae, which CMS models as a significant predictor of elevated medical resource utilization.

Capture Annually

HCC 100 must be recaptured every calendar year through a face-to-face encounter with documented clinical evaluation of the sequela. A historical notation in the problem list alone is insufficient — the provider must document the active clinical relevance of the post-stroke aphasia during the visit. Under CMS-HCC v28, using the more specific I69.320 over a generic neurological symptom code like R47.01 is essential, as only the sequela code maps to the HCC. Failure to capture annually results in loss of the RAF coefficient for that payment year.

🏥 MS-DRG Assignment

MDC 01 — Diseases and Disorders of the Nervous System

DRGTitleEst. Relative Weight*
DRG 091Other Disorders of Nervous System with MCC~1.6-1.9
DRG 092Other Disorders of Nervous System with CC~1.1-1.3
DRG 093Other Disorders of Nervous System without CC/MCC~0.7-0.9

Approximate. Verify against IPPS FY2026 Final Rule tables (CMS v43 MS-DRG Definitions Manual).

Sequencing and Complications

I69.320 as the principal diagnosis on an inpatient admission (e.g., acute rehabilitation admission or direct admission for post-stroke aphasia management) groups to MDC 01, DRG 091/092/093 family based on the CC/MCC tier. When I69.320 is a secondary diagnosis alongside an acute neurological principal (e.g., acute ischemic stroke I63.x), verify its CC/MCC status against the CMS v43 CC/MCC exclusion table — sequela codes may not always activate CC credit when paired with a causally related principal diagnosis. Critical sequencing rule: I69.x codes are never assigned as the principal or secondary diagnosis during the same encounter as the acute stroke itself; they are assigned at all subsequent encounters documenting residual deficits.

🔗 Related ICD-10-CM Codes

Speech and Language Deficit Variants (I69.32x Family)

CodeDescription
I69.320Aphasia following cerebral infarction ← This Code
I69.321Dysphasia following cerebral infarction
I69.322Dysarthria following cerebral infarction
I69.323Fluency disorder following cerebral infarction
I69.328Other speech and language deficits following cerebral infarction

Aphasia by Etiology — Alternative Code Families

CodeDescription
R47.01Aphasia, NOS (no confirmed etiology; symptom code)
I69.120Aphasia following nontraumatic intracerebral hemorrhage
I69.020Aphasia following nontraumatic subarachnoid hemorrhage
I69.220Aphasia following other nontraumatic intracranial hemorrhage
I69.820Aphasia following other cerebrovascular disease
I69.920Aphasia following unspecified cerebrovascular disease

Commonly Co-documented Sequelae of Cerebral Infarction

CodeDescription
I69.351Hemiplegia following CI, right dominant side
I69.352Hemiplegia following CI, left non-dominant side
I69.391Other sequelae of cerebral infarction (includes dysphagia)
I69.310Attention and concentration deficit following CI
I69.311Memory deficit following CI

🛠️ Commonly Associated CPT Codes (Neurology / SLP / PM&R)

Outpatient and Profee Setting Context

ICD-10-CM I69.320 is the primary diagnosis supporting medical necessity for speech-language pathology evaluation and treatment services in the outpatient setting. In the profee setting, SLP evaluation codes (92521-92524) and individual treatment (92507) are the most frequently paired CPT codes. Modifier -GN is required on all SLP claim lines for Medicare to identify the service as speech-language pathology.

CPT CodeDescriptionProfee Coding Notes
92521Evaluation of speech fluency (e.g., stuttering)Less common for post-stroke aphasia; use when fluency is the primary focus; modifier -GN for Medicare SLP
92522Evaluation of speech sound productionUse when articulation/dysarthria is the primary evaluation focus rather than aphasia language processing
92523Evaluation of speech sound production with evaluation of language comprehension and expressionMost appropriate initial evaluation code when both motor speech and language deficits are assessed together in a post-stroke patient
92524Behavioral and qualitative analysis of voice and resonanceUse when voice/resonance is the primary focus post-stroke; less common for aphasia
92507Treatment of speech, language, voice, communication, and/or auditory processing disorder, individualPrimary treatment code for post-stroke aphasia SLP sessions; modifier -GN required for Medicare; -KX modifier when therapy cap threshold exceeded
97129Therapeutic interventions that focus on cognitive function, initial 15 minutesUse when cognitive deficits (I69.31x) co-occurring with aphasia are the primary focus of the session; do not overlap time with 92507
99213 / 99214Office or other outpatient visit, established patientNeurology or PM&R E/M for follow-up of post-stroke sequelae; modifier -25 required on E/M when same-day SLP procedure also billed by the same provider entity

NCCI Bundling Considerations

  • 92507 billed on the same day as 92523 (SLP evaluation): CMS does not expect treatment and evaluation to be billed for the same patient on the same date by the same provider unless the evaluation and treatment were distinctly separate encounters. Document that the evaluation was completed before treatment was initiated, and that treatment was provided in a separate session or clearly delineated time block.

🔬 ICD-10-PCS Crosswalk (Inpatient Procedures)

When I69.320 is an inpatient diagnosis, these PCS codes are relevant for associated inpatient rehabilitation procedures.

PCS SectionBody SystemRoot OperationClinical Application
F (Physical Rehab & Diagnostic Audiology)0 (Rehabilitation)6 (Speech Treatment)Individual SLP speech treatment targeting aphasia: F06Z0ZZ — Speech Treatment, Communicative/Cognitive Integration Skills, None
F (Physical Rehab & Diagnostic Audiology)0 (Rehabilitation)3 (Motor and/or Nerve Function Assessment)Assessment of oral motor, speech fluency, and voice: F01ZZZZ — Motor Function Assessment
G (Mental Health)Z (None)F (Group Psychotherapy)Group aphasia communication therapy in inpatient rehab: GZF2ZZZ — Group Psychotherapy, None Qualifier

💊 Coding Scenarios and Examples

Scenario 1 — Outpatient SLP Clinic: Established Post-Stroke Aphasia, Follow-Up Treatment

Clinical Vignette: A 68-year-old male, 4 months post left-hemisphere ischemic stroke, presents to outpatient SLP for ongoing aphasia treatment. Provider documentation states: “Patient with known expressive aphasia following prior cerebral infarction. Speech output remains telegraphic; comprehension intact. Continuing individual speech-language treatment targeting word retrieval and phrase production.” The treating SLP documents 45 minutes of individual treatment. No E/M service was performed this date.

CPT / HCPCS (Profee):

  • 92507-GN x3 units — Individual SLP treatment, speech/language disorder; GN modifier for Medicare SLP plan of care; 45 minutes = 3 units under the 8-minute rule

Principal / Primary Diagnosis:

  • I69.320 — Aphasia following cerebral infarction (established causal link documented; primary medical necessity driver)

Secondary Diagnoses:

  • I69.351 — Hemiplegia following CI, right dominant side (co-documented sequela; supports complexity)

Scenario 2 — Inpatient Acute Rehab: Post-Stroke Admission with Global Aphasia and Hemiplegia

Clinical Vignette: A 74-year-old female is admitted to inpatient acute rehabilitation 12 days following a left MCA territory ischemic stroke. Admitting diagnoses per attending: “Global aphasia and right hemiplegia following recent cerebral infarction; Type 2 diabetes mellitus with polyneuropathy; hypertension.” Rehabilitation course includes PT, OT, and SLP daily. Patient requires moderate assist for all ADLs.

Principal Diagnosis:

  • I69.320 — Aphasia following cerebral infarction (primary reason for admission to inpatient rehab)

Secondary Diagnoses:

  • I69.351 — Hemiplegia following CI, right dominant side (CC — supports DRG tier elevation)
  • E11.40 — Type 2 diabetes mellitus with diabetic neuropathy, unspecified (CC — comorbidity affecting rehab course)
  • I10 — Essential (primary) hypertension (active comorbidity; not CC/MCC alone but documents complexity)

MS-DRG Assignment: With I69.351 and E11.40 functioning as CCs, the encounter groups to DRG 092 (Other Disorders of Nervous System with CC), assuming no MCC is present. If respiratory failure, sepsis, or other MCC is documented, reassign to DRG 091.

Scenario 3 — CDI Query: Vague Speech Deficit Documentation

Clinical Vignette: A 70-year-old male with a documented history of prior ischemic stroke 2 years ago presents for a neurology follow-up. The physician’s note reads: “Patient continues to have some speech problems since his stroke. He struggles to find words sometimes but communicates adequately.” No specific aphasia type or speech-language deficit category is named in the note.

Action / Outcome: The documentation does not clearly support I69.320 (aphasia — which implies significant/complete language impairment) vs. I69.321 (dysphasia — partial impairment) vs. I69.322 (dysarthria — motor speech). “Word-finding difficulty” leans toward I69.321 (dysphasia) or I69.328 (other speech/language deficit), but a CDI query is required before coding.

Query Response: Provider updates documentation to confirm: “Patient has post-stroke anomic dysphasia — word-finding deficits with otherwise intact language structure and comprehension. This is a residual sequela of his 2022 left MCA ischemic stroke.”

Corrected ICD-10-CM Coding:

  • I69.321 — Dysphasia following cerebral infarction (provider confirmed dysphasia with word-finding deficit; I69.320 would overstate severity)
  • Z87.39 — Personal history of other endocrine, nutritional, and metabolic diseases (do not use Z86.73 — residual deficit is present)

⚠️ Coding Pitfalls and Tips

Pitfall or Tip
❌Using R47.01 instead of I69.320 when stroke etiology is documented. R47.01 is a symptom code appropriate only when aphasia has no confirmed etiology. Once the record confirms aphasia is causally linked to a prior cerebral infarction, I69.320 is the required code. Using R47.01 misses the HCC capture, understates clinical specificity, and can trigger payer medical necessity reviews.
❌Assigning I69.320 during the acute stroke admission. Sequela codes (I69.x) are never assigned during the same encounter as the acute stroke. During the acute admission, assign the appropriate I63.x code for the acute infarction. I69.320 applies at all subsequent encounters where residual aphasia is documented — inpatient rehab, outpatient SLP, neurology follow-up, etc.
❌Confusing aphasia (I69.320) with dysarthria (I69.322). Dysarthria is a motor speech disorder (slurred, slow, imprecise articulation) — language formulation is intact. Aphasia is a language disorder. These are clinically and anatomically distinct; coding one for the other creates a clinical documentation mismatch that can fail utilization review and SLP billing justification.
✅Query for aphasia subtype when documentation is ambiguous. When the provider writes “speech problems,” “communication difficulties,” or similar non-specific language, query before assigning any I69.32x code. The distinction between aphasia, dysphasia, and dysarthria drives both clinical and billing accuracy — and the CDI query standard requires you to ask rather than assume.
✅Capture I69.320 annually for HCC purposes. HCC 100 must be re-documented and recaptured every plan year through a face-to-face encounter. Build an HCC capture workflow for neurology and PM&R follow-up encounters for post-stroke patients — the RAF coefficient for HCC 100 is clinically and financially significant for Medicare Advantage contracts.
✅Code all documented sequelae, not just aphasia. Post-stroke patients commonly carry multiple I69.3xx codes simultaneously — hemiplegia, cognitive deficits, dysphagia, and aphasia may all be present and separately documentable. Assigning all documented sequelae fully captures DRG complexity, supports SLP/PT/OT medical necessity, and reflects the true clinical burden. Never limit sequela coding to one code per encounter when multiple deficits are documented.

📚 Sources

1 CMS/NCHS. ICD-10-CM Official Guidelines for Coding and Reporting, FY2026. Section I.C.9 (Cerebrovascular Disease), Section I.B.10 (Sequela/Late Effects).

2 CMS. IPPS Final Rule FY2026 — MS-DRG Definitions Manual v43. MDC 01 logic tables, DRG 091/092/093 grouper criteria.

3 CMS. 2025-2026 Medicare Advantage Risk Adjustment — CMS-HCC Model v28 ICD-10-CM Mappings. HCC 100 — Ischemic or Unspecified Stroke coefficient tables.

4 Blue Cross NC. Documentation and Coding Guidelines for HCC v28 — Risk Adjustment Code Reference. I69.320 listed under HCC-mapped sequelae of cerebral infarction (2025).

5 AMA. CPT Professional Edition 2026. Speech-Language Pathology subsection — 92507, 92521-92524.

6 CMS. NCCI Policy Manual, Chapter 11 — Physical Medicine and Rehabilitation, 2024-2025. SLP bundling and unbundling guidance.

7 Providers Care Billing. “R47.01 vs I69.320: Coding Aphasia With and Without Stroke.” (2025). https://providerscarebilling.com/r47-01-vs-i69-320-coding-aphasia-with-and-without-stroke/

8 icdlist.com. “ICD-10-CM Diagnosis Code I69.32 — Speech and Language Deficits Following Cerebral Infarction.” (2025). https://icdlist.com/icd-10/I69.32

9 AAPC. “ICD-10 Code I69.320 — Aphasia Following Cerebral Infarction.” https://www.aapc.com/codes/icd-10-codes/I69.320

10 CMS. Medicare Benefit Policy Manual, Chapter 15, §§220-230 — Outpatient Speech-Language Pathology Services.

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