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I69.390

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🧬 ICD-10 CM I69.390 — Apraxia Following Cerebral Infarction

Billable Code Confirmed

ICD-10 CM I69.390 is a valid, fully billable 7-character ICD-10-CM diagnosis code effective for FY2026. It belongs to the I69.39 subcategory (Other Sequelae of Cerebral Infarction) and specifically identifies apraxia — an acquired motor planning disorder — as a residual sequela of a prior cerebral infarction. No additional characters are required; this code stands as fully specified at the 7-character level. It is designated as POA-Exempt (Present on Admission reporting is not required) because sequela codes by definition reflect conditions arising after the acute episode.1,2

Non-Billable Parent Codes

I69 (Sequelae of cerebrovascular disease) — 3-character category header; non-billable and requires subcategory and full code specificity before submission on any claim.1 I69.3 (Sequelae of cerebral infarction) — 4-character subcategory; non-billable as it lacks specificity to identify the type of sequela; additional characters are required.1 I69.39 (Other sequelae of cerebral infarction) — 5-character subcategory; non-billable; it serves as the grouping node for apraxia, dysphagia, facial weakness, and ataxia sequelae but must be extended to specify the exact sequela type.1

Clinical Context

ICD-10 CM I69.390 captures apraxia — a cognitive-motor disorder in which the patient cannot perform purposeful, learned movements despite intact motor strength, coordination, and comprehension. After stroke, apraxia arises from damage to the cortical motor planning networks, particularly in the left hemisphere (dominant parietal and premotor cortex), and may manifest as limb/ideomotor apraxia, buccofacial/oral apraxia, or apraxia of speech. This distinction matters clinically because different apraxia subtypes drive different therapy referrals: limb apraxia → occupational therapy; buccofacial and speech apraxia → speech-language pathology. Accurate coding of I69.390 directly supports medical necessity justification for these therapy services and inpatient rehabilitation admission.3,4,5

Code Classification

ICD-10 CM I69.390 is a diagnosis code classifying a sequela (late effect) of a prior cerebrovascular event — it is not a procedure code, and it is not an acute condition code. It must only be assigned when provider documentation explicitly links the current apraxia to the prior cerebral infarction; ICD-10-CM Official Guidelines require this causal linkage to be documented by the treating provider, not inferred by the coder alone.1,2

🔍 Code Description

ICD-10 CM I69.390 identifies apraxia as a residual manifestation of a prior cerebral infarction. apraxia is a higher-order motor planning disorder — meaning the deficit lies not in muscle strength, sensation, or basic coordination, but in the brain’s ability to retrieve and execute the motor programs required to perform intentional, purposeful movements. The most common forms seen post-stroke include ideomotor apraxia (inability to perform gestures or tool use on command while retaining automatic use), ideational apraxia (breakdown of multi-step sequential actions), and buccofacial apraxia (inability to perform voluntary oral movements such as blowing, coughing, or licking the lips on command). Apraxia of speech — a specific disruption in the motor planning of articulation — may also be captured here when not already addressed under the I69.32x speech and language deficit subcategory, though clinical documentation should guide the most specific code selection.1,3,4,5

The code sits within the I69.39 subcategory, which contains “Other Sequelae of Cerebral Infarction” — a grouping that includes I69.391 (Dysphagia following CI), I69.392 (Facial weakness following CI), I69.393 (ataxia following CI), and I69.398 (Other sequelae of CI). apraxia is clinically distinct from all of these: it is not a weakness (which would imply motor neuron or muscle pathology), not an ataxic coordination disorder, and not purely a swallowing or speech articulation deficit. Recognizing this distinction is critical for both accurate code selection and for ensuring the correct therapy discipline is authorized and reimbursed. Coders should query providers when the record reflects occupational therapy or speech-language pathology documentation of apraxia but the attending’s documentation only states “motor deficits” or “neurological sequelae NOS.”1,2,3

🌳 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
│   ├── I69.32 — Speech and language deficits following cerebral infarction ❌ Non-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
│   ├── I69.36 — Other paralytic syndrome following cerebral infarction ❌ Non-billable
│   │
│   └── I69.39 — Other sequelae of cerebral infarction ❌ Non-billable
│       │
│       ├── I69.390 — Apraxia following cerebral infarction ◀ THIS CODE ✅ Billable
│       ├── I69.391 — Dysphagia following cerebral infarction ✅ Billable
│       ├── I69.392 — Facial weakness following cerebral infarction ✅ Billable
│       ├── I69.393 — Ataxia following cerebral infarction ✅ Billable
│       └── I69.398 — Other sequelae of cerebral infarction ✅ Billable
│
└── I69.8 — Sequelae of other cerebrovascular diseases ❌ Non-billable

Apraxia vs. Aphasia vs. Dysarthria — Choose Carefully

apraxia of speech (I69.390) affects motor planning of articulation and is distinct from aphasia (I69.320 — language formulation breakdown) and dysarthria (I69.322 — muscle weakness/coordination affecting speech). All three can co-occur after left hemisphere stroke. When the SLP documents all three, all three should be coded separately — they are distinct conditions, not synonyms. Defaulting to I69.390 for all speech disorders post-stroke is a frequent and auditable coding error.1,2,3

No Laterality Character for I69.390

Unlike hemiplegia/hemiparesis codes (I69.35x), apraxia sequela codes carry no laterality character. If the provider documents left vs. right limb apraxia or specifies which hemisphere was infarcted, that clinical detail belongs in the documentation but cannot be captured in I69.390 itself. This is a known specificity limitation of the current ICD-10-CM structure for apraxia sequelae.1

✅ Includes

  • Ideomotor apraxia following CI: Inability to perform a skilled movement in response to a verbal command (e.g., “show me how you use a hammer”) despite being able to perform it automatically; most common form after left hemisphere parietal infarction.3,4
  • Ideational apraxia following CI: Breakdown in sequencing multi-step tasks (e.g., making coffee, getting dressed); the patient loses the conceptual plan for the action sequence, not just the execution.3,4
  • Buccofacial/oral apraxia following CI: Inability to perform voluntary facial movements on command (blowing, coughing, lip-licking) despite preserved automatic execution; commonly co-occurs with aphasia after left MCA territory infarction.4,5
  • Limb-kinetic apraxia following CI: Loss of fine, precise limb movements characterized by clumsy, poorly graded motor acts; often affects the ipsilateral limb to the infarction side.3,4
  • Apraxia of speech (AOS) following CI: Acquired neurological speech sound disorder reflecting impaired planning/programming of the spatial-temporal parameters of movement sequences for speech; distinct from dysarthria.5

❌ Excludes

Excludes 1

  • Z86.73 — Personal history of cerebral infarction without residual deficit: This is a mutually exclusive Excludes 1 relationship. Z86.73 is used only when the prior stroke has left no residual deficits — by definition, if the patient has residual apraxia, Z86.73 cannot be assigned. Assigning both I69.390 and Z86.73 on the same claim represents a logical contradiction and constitutes a direct coding error that will trigger NCCI edits and potential RAC audit flags.1,2
  • S06.- — Sequelae of traumatic intracranial injury: If apraxia results from a traumatic brain injury rather than ischemic cerebral infarction, codes from the S06 injury chapter apply instead of I69.390. I69.390 is etiologically restricted to non-traumatic cerebral infarction (I63.x origin). Confusing traumatic and non-traumatic etiologies is one of the most common cerebrovascular sequela coding errors flagged in payer audits.1,2

Most Common Excludes 1 Error

The most frequent Excludes 1 violation involving I69.390 is the simultaneous assignment of Z86.73 and any I69.39x code on the same claim. This frequently occurs when a coder applies Z86.73 as a “background history” code while also coding active sequelae — this is incorrect. Once any I69.x sequela code is assigned (including I69.390), Z86.73 is excluded from that encounter by definition. This error is a well-documented RAC and OIG audit target for cerebrovascular sequela claims.1,2

Excludes 2

  • There are no formal Excludes 2 notations attached specifically to I69.390. However, per ICD-10-CM guidelines, speech and language deficits (I69.32x — including dysphasia I69.321 and dysarthria I69.322) may be coded separately alongside I69.390 when both apraxia and distinct language/articulation deficits are documented and treated. These are clinically distinct conditions and co-coding is appropriate and expected when supported by SLP documentation.1,2

📋 Clinical Overview

Post-stroke motor and speech disorders exist on a spectrum, and ICD-10-CM differentiates them precisely because each drives distinct rehabilitation pathways and requires separate medical necessity justification. Apraxia (I69.390) is a motor planning disorder — the neural program for the movement is disrupted, not the motor neuron pathway, muscle, or coordination system. This distinguishes it cleanly from weakness (hemiplegia/paresis) and ataxia (coordination loss), and from language formulation disorders (aphasia/dysphasia). CDI specialists should query providers whenever OT or SLP notes describe apraxia but the attending only documents “motor deficits” or “speech impairment” without specifying the mechanism.3,4,5

FeatureI69.390I69.393I69.322
Deficit TypeMotor planning/programming — inability to execute learned purposeful movementsAtaxia — coordination breakdown in movement executionDysarthria — motor speech disorder due to muscle weakness or incoordination
Underlying MechanismDamage to cortical motor planning networks (left parietal, premotor cortex)Damage to cerebellar pathways or cerebellar connections via infarctDamage to motor neurons, cerebellum, or brainstem affecting speech musculature
Key Clinical SignMovements impaired on command but preserved automatically; errors are variable and inconsistentLimb or gait incoordination; dysmetria; intention tremor; broad-based gaitSlurred, slow, or imprecise articulation; consistent error pattern; effort-related
Primary Rehab DisciplineOT (limb/ideomotor apraxia); SLP (buccofacial/speech apraxia)PT (gait ataxia); OT (limb ataxia); neurologistSLP (speech therapy for motor speech disorder)
Common Infarct LocationLeft MCA territory (parietal lobe, premotor cortex)Posterior circulation (PICA, SCA territory); cerebellar infarctionCorticobulbar tract; brainstem; cerebellar peduncles

CDI Query Trigger

When the occupational therapy or SLP note documents apraxia — particularly ideomotor apraxia on formal testing or apraxia of speech per standardized assessment — but the attending’s notes only state “post-stroke weakness” or “speech difficulties,” a CDI query is warranted to ask the provider to specify apraxia as the diagnosis and confirm the causal link to the prior infarction. Without this linkage, ICD-10-CM guidelines prohibit code assignment and the medical necessity documentation for the associated therapy services is weakened.1,2

Manifestations & Symptom Burden

  • Limb/ideomotor apraxia: Cannot pantomime tool use on command (e.g., “show me how you brush your teeth”) but may retain automatic use; most commonly affects dominant left hemisphere lesions, manifesting in the right upper extremity; heavily impacts ADL independence.3,4
  • Buccofacial/oral apraxia: Cannot voluntarily perform isolated oral movements (e.g., cough, pucker, lick lips) on command despite intact automatic execution; frequently co-occurs with aphasia in left MCA territory infarctions; SLP assessment required.4,5
  • Apraxia of speech: Distorted sound substitutions, variable errors, groping articulatory movements, difficulty initiating speech, and prosodic abnormalities; distinct from dysarthria’s consistent hypernasality or slurring pattern; formally assessed by SLP.5
  • Dressing apraxia: Inability to correctly orient and apply garments to the body; spatial-motor integration failure; may also overlap with visuospatial deficit (I69.312) and both codes should be considered when documented.3
  • Constructional apraxia: Difficulty copying drawings or assembling block constructions; reflects spatial planning breakdown; may co-occur with or overlap visuospatial deficit coding — query provider to specify the primary deficit type.3,4

Manifestation Coding Rules for I69.390

ICD-10 CM I69.390 is itself the sequela/manifestation code — no separate “cause” code for the original infarction is required when using it, because the causal linkage to “cerebral infarction” is already embedded in the code descriptor per ICD-10-CM sequela coding rules (Section I.B.10). Do NOT add a concurrent I63.x code unless the patient is experiencing a new acute infarction during this same encounter. When multiple distinct sequelae coexist (e.g., both apraxia and dysphagia), each should be captured with its own I69.39x code — do not default to I69.398 (Other) if a specific code (I69.390, I69.391) applies.1,2

💰 HCC Risk Adjustment

ModelHCC CategoryHCC LabelRAF Value
CMS-HCC (Medicare Advantage)Not MappedNo HCC0.000
HHS-HCC (ACA/Marketplace)Not MappedNo HCC0.000
RxHCCNot MappedNo HCC0.000

ICD-10 CM I69.390 does not generate a Risk Adjustment Factor score under any current CMS risk adjustment model. Per Blue Cross NC provider documentation and CMS guidance, I69.390 is explicitly listed as a “No HCC” code within the I69.39x subcategory, consistent with all non-motor-deficit I69.3xx sequela codes.6,7 This means annual recapture efforts will not yield RAF uplift. However, the code remains essential for inpatient rehabilitation admission medical necessity, skilled therapy authorization, severity-of-illness documentation, and quality metric accuracy. Organizations participating in bundled payment or value-based care arrangements should still ensure I69.390 is captured when documented, as functional complexity metrics and post-acute care resource utilization modeling depend on this specificity.6

🏥 MS-DRG Assignment

ScenarioPrincipal DxSecondary DxMS-DRGMDC
Inpatient rehab admission — apraxia principalI69.390I69.391 (dysphagia), I69.321 (dysphasia)DRG 056 (with MCC) or DRG 057 (without MCC) — Degenerative Nervous System DisordersMDC 01
Acute stroke admissionI63.411 (new acute CI)I69.390 (pre-existing sequela from prior CI)DRG 065/066 — Intracranial Hemorrhage or Cerebral Infarction ± CC/MCCMDC 01
SNF / post-acute stayI69.390Additional residual sequelaeDRG 056/057 or other MDC 01 DRGs depending on full DX profileMDC 01

I69.390 carries no CC or MCC designation and will not independently shift the DRG tier when used as a secondary diagnosis. When it serves as the principal diagnosis on a post-acute or rehabilitation inpatient admission, the DRG will be refined by the presence or absence of MCCs in the secondary diagnosis list — ensuring complete documentation of all concurrent conditions is critical for accurate DRG assignment and fair reimbursement. I69.390 should never be sequenced as the principal diagnosis during the index acute infarction stay; its use during the acute admission is appropriate only as a secondary diagnosis reflecting a residual from a prior infarction. This sequencing error is a frequently cited finding in inpatient coding audits for cerebrovascular cases.1,2

🔗 Related ICD-10-CM Codes

Other Sequelae of Cerebral Infarction (I69.39x Family):

  • I69.391 — Dysphagia following cerebral infarction (use additional code R13.1- to identify type)
  • I69.392 — Facial weakness following cerebral infarction (includes facial droop following CI)
  • I69.393 — Ataxia following cerebral infarction
  • I69.398 — Other sequelae of cerebral infarction (alteration of sensation, disturbance of vision — use additional code to identify)

Apraxia in Other Cerebrovascular Sequelae:

  • I69.090 — Apraxia following nontraumatic subarachnoid hemorrhage
  • I69.190 — Apraxia following nontraumatic intracerebral hemorrhage
  • I69.290 — Apraxia following other nontraumatic intracranial hemorrhage
  • I69.890 — Apraxia following other cerebrovascular disease
  • I69.990 — Apraxia following unspecified cerebrovascular disease

Potentially Co-occurring Sequelae Codes:

  • I69.320 — Aphasia following cerebral infarction (frequently co-occurs with buccofacial apraxia)
  • I69.321 — Dysphasia following cerebral infarction
  • I69.322 — Dysarthria following cerebral infarction (distinct from apraxia of speech — code both when documented)
  • I69.312 — Visuospatial deficit and spatial neglect following CI (may co-occur with constructional/dressing apraxia)

🛠️ Commonly Associated CPT Codes

  • 97530 — Therapeutic activities, each 15 minutes: OT use of task-specific, functional activity training targeting limb/ideomotor apraxia is billed under this code; I69.390 serves as a primary supporting medical necessity diagnosis for reimbursement of functional activity intervention.8
  • 97129/97130 — Therapeutic interventions focusing on cognitive function (first 15 min / each additional 15 min): When OT or SLP performs strategy training, errorless learning, or gesture training for apraxia, these cognitive function intervention codes may apply; I69.390 is a valid supporting diagnosis for medical necessity.8
  • 92521 — Evaluation of speech fluency: SLP evaluation of speech fluency and motor speech planning, including apraxia of speech assessment; I69.390 supports medical necessity for this evaluation service.8
  • 92522/92523 — Evaluation of speech sound production: SLP evaluation of speech sound production with (92523) or without (92522) language comprehension testing; commonly used at initial SLP evaluation when apraxia of speech following CI is the suspected diagnosis.8
  • 97535 — Self-care/home management training, each 15 min: ADL training for patients with limb or dressing apraxia targets compensatory strategies for independent functioning; I69.390 is a direct medical necessity anchor for this OT service.8
  • 92507 — Treatment of speech, language, voice, communication, and/or auditory processing disorder: SLP treatment for apraxia of speech and buccofacial apraxia following CI; one of the most commonly associated CPT codes when I69.390 is the active diagnosis in speech therapy plans of care.8

NCCI Bundling Considerations

When billing evaluation CPT codes (e.g., 92521, 92522, 92523) alongside therapeutic treatment codes (92507, 97530) on the same date of service, NCCI bundling edits may apply — a modifier -59 (or XS/XU/XP as applicable) may be required to establish the distinct and separate nature of the evaluation and treatment services. Same-day billing of initial evaluation (e.g., 97165 OT evaluation) and treatment (97530) without separate documentation of distinct services will trigger edits. Always confirm that the treating therapist’s documentation specifies separate, time-stamped activities when multiple codes are submitted with I69.390 as the supporting diagnosis.1,2

🔬 ICD-10-PCS Crosswalk

  • F06Z6EZ — Speech Assessment, Motor Speech / Attention Processing: When an SLP performs a formal inpatient assessment of apraxia of speech or buccofacial apraxia in the inpatient rehab or acute setting, this PCS code from Section F (Physical Rehabilitation and Diagnostic Audiology) may apply; confirms and supports I69.390 as the associated diagnosis code.1
  • F07Z6EZ — Speech Treatment, Attention Process Training: Inpatient SLP treatment targeting motor speech planning and apraxia of speech may be captured under this Section F PCS code; the treatment must be specifically documented as addressing motor planning/apraxia rather than general speech therapy.1
  • F08Z6EZ — Activities of Daily Living Treatment: OT intervention in the inpatient rehab setting targeting ADL deficits secondary to limb or dressing apraxia may be captured under this PCS rehabilitation code; pairs with I69.390 as the supporting diagnostic code for DRG documentation completeness.1
  • GZ3ZZZZ — Psychological Tests: When formal neuropsychological evaluation of motor praxis (e.g., standardized apraxia battery) is performed in the inpatient setting, this Mental Health section PCS code may apply to capture the assessment.1

💊 Coding Scenarios and Examples

Scenario 1: Inpatient Rehab Admission — Limb Apraxia Post-Stroke

A 71-year-old right-handed female is admitted to an acute inpatient rehabilitation unit 4 weeks following a left MCA territory cerebral infarction. OT evaluation documents moderate ideomotor apraxia of the right upper extremity — patient cannot pantomime tool use on command but retains automatic use of utensils during meals. SLP concurrently documents mild buccofacial apraxia with difficulty performing isolated oral movements on command. The attending physician documents “apraxia following left hemisphere infarction” in the admission H&P.

Correct Coding:

  • I69.390 — Apraxia following cerebral infarction (principal)
  • I69.321 — Dysphasia following cerebral infarction (secondary — if also documented)

Sequencing: I69.390 is appropriate as the principal diagnosis for this rehab admission since it represents the primary reason for the inpatient stay. CDI Note: Confirm the attending has explicitly documented both the apraxia diagnosis AND its causal link to the prior infarction — therapist-only documentation of apraxia is insufficient for code assignment per Official Guidelines.1,2

Scenario 2: Outpatient SLP Evaluation — Apraxia of Speech

A 65-year-old male presents to an outpatient speech-language pathology clinic 2 months post-left hemisphere cerebral infarction. SLP performs a comprehensive motor speech evaluation (CPT 92523) and documents apraxia of speech: inconsistent articulatory errors, groping movements, prosodic abnormalities, and severe difficulty initiating volitional speech. The referring neurologist’s note documents “apraxia of speech following CI” confirming the diagnosis and causal linkage.

Correct Coding:

  • I69.390 — Apraxia following cerebral infarction
  • I69.320 — Aphasia following cerebral infarction (if co-occurring aphasia is also documented and addressed)

Sequencing: Sequence the primary reason for the visit first. Do not assign Z86.73 — the presence of residual apraxia of speech is definitionally incompatible with Z86.73. Do not assign I69.322 (dysarthria) unless dysarthria is separately documented in addition to the apraxia of speech.1,2,3

Scenario 3: Acute Stroke Admission with Pre-Existing Apraxia

A 78-year-old male is admitted via the ED with a new right hemisphere cerebral infarction (posterior MCA territory). Review of prior medical records reveals a 2-year-old left hemisphere infarction with documented residual ideomotor apraxia that is ongoing and is noted in the admitting H&P as an active problem affecting the current inpatient management and therapy planning.

Correct Coding:

  • I63.412 — Cerebral infarction due to embolism of left middle cerebral artery (principal — current acute event)
  • I69.390 — Apraxia following cerebral infarction (secondary — pre-existing residual sequela from prior CI, documented as affecting current management)

Sequencing: The new acute infarction is always the principal diagnosis during the acute admission. I69.390 may be captured as a secondary diagnosis only if it is documented as being monitored or treated during this stay. CDI Note: Do not omit I69.390 if the attending acknowledges and plans for the apraxia — even without RAF value, it contributes to severity of illness and supports therapy service orders during the acute stay.1,2

⚠️ Coding Pitfalls and Tips

  1. Do not use I69.390 as the principal diagnosis during the acute stroke inpatient admission. This is a sequela code — by definition, it represents a late effect persisting after the acute infarction episode has concluded. Sequencing it as principal during the index acute stay will cause DRG misassignment and is a primary MAC/RAC audit target. The acute cerebral infarction (I63.x) must serve as principal during the acute inpatient stay.1,2

  2. Never co-assign Z86.73 with I69.390. This Excludes 1 violation is the single most frequently cited cerebrovascular sequela coding error in audit findings. Z86.73 states “no residual deficits” — if apraxia is present and being coded, Z86.73 is categorically excluded from the same claim. No exception exists.1,2

  3. Apraxia of speech and dysarthria are NOT the same — do not use I69.390 and I69.322 interchangeably. apraxia of speech is a motor planning disorder with inconsistent, variable errors and groping; dysarthria is a motor execution disorder with consistent patterns related to muscle weakness or incoordination. When an SLP documents both conditions separately after formal assessment, both I69.390 AND I69.322 should be coded — they are not bundled and payers expect specificity.3,5

  4. Therapist documentation alone is insufficient to assign I69.390. Per ICD-10-CM Official Guidelines, the treating physician or advanced practice provider must document and link the diagnosis to the prior infarction. When OT or SLP notes document apraxia but attending notes are silent on the diagnosis, a CDI query is required before the code can be assigned. This is one of the most common CDI gaps on post-acute and rehabilitation inpatient claims.1,2

  5. Do not default to I69.398 (Other sequelae) when I69.390 (Apraxia) clearly applies. I69.398 is a catch-all code for sequelae not specifically classified elsewhere (e.g., alteration of sensation, disturbance of vision). When the provider documents apraxia specifically, I69.390 is required by the ICD-10-CM specificity guidelines — using I69.398 for a documented apraxia diagnosis is a nonspecific coding error that may prompt payer review.1,2

  6. I69.390 carries zero RAF value — but document and code it anyway. The absence of HCC mapping does not reduce the clinical or operational importance of this code. It directly supports: skilled therapy medical necessity (OT, SLP), inpatient rehabilitation admission justification, severity-of-illness accuracy for CMI reporting, and quality outcome tracking under stroke core measures. CDI and coding teams should treat it as a completeness requirement, not an optional addition.6,7

📚 Sources

1. Centers for Medicare & Medicaid Services (CMS) & National Center for Health Statistics (NCHS). *ICD-10-CM Official Guidelines for Coding and Reporting, FY2026.* U.S. Department of Health and Human Services; 2026. https://www.cms.gov/medicare/coding-billing/icd-10-codes 2. AAPC. *ICD-10-CM Code I69.390 — Apraxia following cerebral infarction.* AAPC Coder; 2026. https://www.aapc.com/codes/icd-10-codes/I69.390 3. Stroke Engine. *Apraxia following stroke: assessment and clinical overview.* StrokEngine; 2020. https://strokengine.ca/en/consequences/apraxia/ 4. van Heugten CM, Dekker J, Deelman BG, et al. *Outcome of strategy training in stroke patients with apraxia: a phase II study.* Clin Rehabil. 1998;12(4):294–303. 5. Neurolutions. *Apraxia Explained: Causes, Types, Symptoms, and Treatment Options.* Neurolutions; 2025. https://www.neurolutions.com/after-stroke/apraxia-explained-causes-types-symptoms-and-treatment-options/ 6. Blue Cross and Blue Shield of North Carolina. *HCC Risk Adjustment Coding Documentation Guide — ICD-10 Sequelae of Cerebrovascular Disease.* BCBS NC; 2023. https://www.bluecrossnc.com/providers 7. CMS. *2026 Benefit Year Final HHS Risk Adjustment Model Coefficients.* Centers for Medicare & Medicaid Services; January 2025. https://www.cms.gov/files/document/2026-benefit-year-final-hhs-risk-adjustment-model-coefficients2025-01-13.pdf 8. American Medical Association. *CPT 2026 Professional Edition.* AMA Press; 2026. [CPT codes 92507, 92521, 92522, 92523, 97129, 97130, 97530, 97535]

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