I69.351

🧬 ICD-10 CM I69.351 — Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side

Billable Code Confirmed

ICD-10 CM I69.351 is a valid, billable 7-character ICD-10-CM code for FY2025. All seven characters are present: I69 (category) + .3 (sequelae of cerebral infarction) + 5 (hemiplegia/hemiparesis) + 1 (right dominant side).

Non-Billable Parent Codes — Never Submit These

• ❌ I69.3 — 4-character header — missing deficit specification

• ❌ I69.35 — 5-character header — missing laterality and dominance specification

• ❌ I69.359 — 7-character code — unspecified laterality (Avoid unless absolutely necessary, triggers audit flags)

  Always submit I69.351 or the corresponding specific laterality code when hemiplegia is a sequela of an ischemic stroke.

Clinical Context: Acute vs. Sequelae (Late Effects)

Category I69 codes are used for sequelae (late effects) of cerebrovascular diseases. This means the stroke itself is no longer active or being acutely treated. Do not use I69.351 during the acute inpatient admission for the stroke. During the acute phase, use G81.91 (Hemiplegia) along with the acute stroke code (e.g., I63.9). I69.351 is used for subsequent encounters, rehab admissions, or long-term management.

🔍 Code Description

ICD-10 CM I69.351 classifies the long-term neurological deficit of hemiplegia (complete paralysis) or hemiparesis (partial paralysis/weakness) on the right side of the body, secondary to a previous cerebral infarction (ischemic stroke).

This specific code indicates that the right side is the patient’s dominant side (meaning they are right-handed).

ICD-10-CM Default Dominance Guidelines

If the documentation does not specify whether the right side is dominant or non-dominant, and does not state the patient’s handedness, ICD-10-CM guidelines state that for the right side, default to dominant. Therefore, if a note simply says “post-stroke right hemiparesis”, you correctly assign I69.351. (For the left side, the default is non-dominant).

🌳 Code Tree / Hierarchy

I69 Sequelae of cerebrovascular disease ❌ Non-billable
│  
├── I69.3 Sequelae of cerebral infarction ❌ Non-billable
│ │  
│ ├── I69.35 Hemiplegia and hemiparesis following cerebral infarction ❌ Non-billable
│ │ │  
│ │ ├── I69.351 HEMIPLEGIA AND HEMIPARESIS... AFFECTING RIGHT DOMINANT SIDE ◀ THIS CODE ✅
│ │ ├── I69.352 Hemiplegia and hemiparesis... affecting left dominant side
│ │ ├── I69.353 Hemiplegia and hemiparesis... affecting right non-dominant side
│ │ └── I69.354 Hemiplegia and hemiparesis... affecting left non-dominant side

✅ Includes

The following clinical scenarios and terms map to I69.351:

• Right-sided weakness/paralysis as a late effect of an ischemic stroke (cerebral infarction)

• Right hemiplegia, unspecified dominance (defaults to dominant)

• Spastic right hemiplegia resulting from old CVA

❌ Excludes

Excludes1 — Cannot be coded together

The Excludes1 note dictates that the following conditions cannot be coded alongside I69.351. They represent either acute conditions or different etiologies:

• Hemiplegia/hemiparesis during the acute phase of a stroke (G81.01 - G81.94)

• Sequelae of nontraumatic intracerebral hemorrhage (I69.151) (Must match the exact stroke type!)

• Sequelae of subarachnoid hemorrhage (I69.051)

🛠️ CPT Procedural Crosswalk — wRVU & Assistant Payable Status

Patients with I69.351 often require comprehensive physical therapy, neuro-rehabilitation, orthotic management, or spasticity treatments like chemodenervation (Botox).

CPT Code	Description	Global Period	wRVU (Facility)	Asst. Surgeon Payable?	Bundling & NCCI Edits
99214	Office/outpatient visit, established patient, moderate complexity	XXX	1.92	No (Indicator 0)	Mutually exclusive with minor procedures unless a significant, separately identifiable E/M is performed (requires modifier -25).
97112	Therapeutic procedure, 1 or more areas, each 15 mins; neuromuscular reeducation	XXX	0.45	No (Indicator 0)	PM&R code. Excludes simultaneous billing with other PT codes for the exact same 15-minute time block.
64642	Chemodenervation of one extremity; 1-4 muscle(s)	010	1.50	No (Indicator 0)	Often performed for post-stroke spasticity. Drug supply billed separately. Do not report alongside trigger point injections for the same muscles.
95860	Needle electromyography; one extremity with or without related paraspinal areas	XXX	1.05	No (Indicator 0)	Usually bundled if billed by the same provider on the same day as E/M without modifier -25.

Note: wRVU values are estimates based on the standard CMS Physician Fee Schedule. Check current year exact values.

💊 Coding Scenarios

Scenario 1 — PM&R Follow-up and Physical Therapy Order

Clinical Vignette: A 68-year-old male presents to the PM&R clinic for a 6-month follow-up of right-sided weakness following a left middle cerebral artery (MCA) ischemic stroke that occurred last year. He is right-handed. The physician notes persistent right arm spasticity and a right foot drop. The provider writes a new prescription for an Ankle-Foot Orthosis (AFO) and orders 8 weeks of neuromuscular re-education therapy.

CPT / HCPCS:

• 99214 — Office/outpatient visit, est. patient, moderate complexity

• L1960 — Ankle foot orthosis, plastic or other material, custom-fabricated (if dispensed by the provider)

ICD-10-CM:

• I69.351 — Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side (Primary diagnosis for the encounter)

• R29.810 — Facial weakness (If documented as a remaining concurrent sequela)

Scenario 2 — Chemodenervation (Botox) for Spastic Hemiplegia

Clinical Vignette: A 70-year-old right-handed female with right hemiplegia secondary to an old ischemic stroke presents for scheduled botulinum toxin injections to treat severe spasticity in her right upper extremity. The neurologist injects a total of 100 units of OnabotulinumtoxinA into the right biceps brachii, flexor carpi radialis, and brachioradialis (3 muscles).

CPT / HCPCS:

• 64642 — Chemodenervation of one extremity; 1-4 muscle(s)

• J0585 — Injection, onabotulinumtoxinA, 1 unit (Bill 100 units)

ICD-10-CM:

• I69.351 — Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side (Identifies the cause of the spasticity)

• M62.838 — Other muscle spasm (Optional secondary to justify the specific symptom treated, though I69.351 implies the neuro-deficit)

⚠️ Coding Pitfalls and Tips

	Pitfall or Tip
❌	Do not use for hemorrhagic stroke late effects: I69.351 is only for ischemic strokes (infarctions). If the patient had a subarachnoid or intracerebral hemorrhage, you must use the I69.0- or I69.1- families, respectively. Check the patient’s history carefully.
❌	Do not combine with acute stroke codes for the SAME event: Do not code I63.- (Acute cerebral infarction) and I69.- on the same inpatient admission record for the same stroke event.
✅	You CAN mix acute and history codes if the patient has a NEW stroke: If a patient who has existing right hemiplegia from an old stroke (I69.351) is admitted today for a brand new left hemisphere stroke (I63.-), you can code both. The I69 code captures the baseline historical deficit, while I63 captures the acute event.
✅	Code ALL sequelae: A patient may have multiple sequelae from a single stroke. You should code them all. If the patient has right hemiplegia and expressive aphasia, code both I69.351 and I69.320 (Aphasia following cerebral infarction).

📚 Sources

1. CMS/NCHS. ICD-10-CM Official Guidelines for Coding and Reporting, FY2025. Chapter 9: Diseases of the Circulatory System — Sequelae of Cerebrovascular Disease.

2. American Medical Association (AMA). CPT 2024/2025 Professional Edition.

3. CMS HCC Risk Adjustment Model V28 category mappings.