I69.352

🧬 ICD-10 CM I69.352 — Hemiplegia and hemiparesis following cerebral infarction affecting left dominant side

Billable Code Confirmed

ICD-10 CM I69.352 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) + 2 (left 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 I69.352 or the corresponding specific laterality code when hemiplegia is a sequela of an ischemic stroke.

Clinical Context: The "Dominance" Default Rule

According to ICD-10-CM Official Guidelines, if the documentation states “left hemiplegia” but does not specify whether the left side is dominant or non-dominant (and does not state the patient’s handedness), the default for the left side is non-dominant (I69.354).

Therefore, to legally and accurately assign I69.352, the provider must explicitly document that the patient is left-handed or that the affected left side is their dominant side.

🔍 Code Description

ICD-10 CM I69.352 classifies the long-term neurological deficit of hemiplegia (complete paralysis) or hemiparesis (partial paralysis/weakness) on the left side of the body, secondary to a previous cerebral infarction (ischemic stroke).

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

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 This means the stroke itself is no longer active or being acutely treated.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 I69.352 during the acute inpatient admission for the stroke. During the acute phase, use an acute hemiplegia code (e.g., G81.92) along with the acute stroke code. I69.352 is used for subsequent encounters, rehab admissions, or long-term management.

🌳 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
│ │ ├── I69.352 HEMIPLEGIA AND HEMIPARESIS... AFFECTING LEFT DOMINANT SIDE ◀ THIS CODE ✅
│ │ ├── 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 I69.352:

• Left-sided weakness/paralysis as a late effect of an ischemic stroke (cerebral infarction) in a left-handed patient

• Spastic left hemiplegia resulting from old CVA in a patient whose left side is dominant

❌ Excludes

Excludes1 — Cannot be coded together

The Excludes1 note dictates that the following conditions cannot be coded alongside I69.352. 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 (I69.152) (Must match the exact stroke type!)

• Sequelae of subarachnoid hemorrhage (I69.052)

• Sequelae of other nontraumatic intracranial hemorrhage (I69.252)

🛠️ CPT Procedural Crosswalk — wRVU & Assistant Payable Status

Patients with I69.352 often require comprehensive physical therapy, occupational therapy, 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.
97760	Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(ies), lower extremity(ies) and/or trunk, initial orthotic(s) encounter, each 15 minutes	XXX	0.45	No (Indicator 0)	Commonly used when fitting an AFO for post-stroke foot drop or an upper extremity resting splint.

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 Occupational Therapy Order

Clinical Vignette: A 72-year-old female presents to the PM&R clinic for a 6-month follow-up of left-sided weakness following a right middle cerebral artery (MCA) ischemic stroke. The physician’s note specifically states, “Patient is left-hand dominant.” She struggles with activities of daily living due to left arm spasticity. The provider orders 6 weeks of occupational therapy for neuromuscular re-education.

CPT / HCPCS:

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

ICD-10-CM:

• I69.352 — Hemiplegia and hemiparesis following cerebral infarction affecting left dominant side (Primary diagnosis for the encounter)

• Z51.89 — Encounter for other specified aftercare (Optional, depending on facility guidelines for therapy referrals)

Scenario 2 — Chemodenervation (Botox) for Left Leg Spasticity

Clinical Vignette: A 65-year-old left-handed male with left hemiplegia secondary to an old ischemic stroke presents for scheduled botulinum toxin injections to treat severe spasticity in his left lower extremity (equinovarus deformity). The neurologist injects a total of 200 units of OnabotulinumtoxinA into the left medial gastrocnemius, lateral gastrocnemius, and soleus (3 muscles).

CPT / HCPCS:

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

• J0585 — Injection, onabotulinumtoxinA, 1 unit (Bill 200 units)

ICD-10-CM:

• I69.352 — Hemiplegia and hemiparesis following cerebral infarction affecting left dominant side (Identifies the specific deficit and etiology)

• M21.372 — Foot drop, left foot (To further specify the exact manifestation being treated, if desired)

⚠️ Coding Pitfalls and Tips

	Pitfall or Tip
❌	Do not assume “Left Dominant”: As noted above, if the chart just says “left hemiparesis,” the ICD-10 default is non-dominant. You must use I69.354 unless you query the provider or find left-handedness explicitly documented elsewhere in the chart.
❌	Do not use for hemorrhagic stroke late effects: I69.352 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.
✅	You CAN mix acute and history codes if the patient has a NEW stroke: If a patient who has existing left hemiplegia from an old stroke (I69.352) is admitted today for a brand new right 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 left-handed patient has left hemiplegia and dysphagia from the same old stroke, code both I69.352 and I69.391 (Dysphagia 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 (Dominance/Non-dominance Default Guidelines).

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

3. CMS HCC Risk Adjustment Model V28 category mappings.