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I69.391

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🧬 ICD-10 CM I69.391 — Dysphagia following cerebral infarction

Billable Code Confirmed

ICD-10 CM I69.391 is a valid, billable 6-character ICD-10-CM code for FY2025. All six characters are present: I69 (category) + .3 (sequelae of cerebral infarction) + 9 (other sequelae) + 1 (dysphagia). No 7th character is required.

Non-Billable Parent Codes — Never Submit These

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

  • ❌ I69.39 — 5-character header — missing exact specification of the “other” sequela

    Always submit I69.391 when dysphagia is explicitly documented as a late effect of an ischemic stroke.

Clinical Context: The "Use Additional Code" Rule

ICD-10 CM I69.391 requires you to pair it with a code from the R13.1- category to identify the specific phase or type of the dysphagia.

  • Code First: I69.391 (Dysphagia following cerebral infarction)
  • Use Additional Code: R13.11 (oral phase), R13.12 (oropharyngeal phase), R13.13 (pharyngeal phase), R13.14 (pharyngoesophageal phase), or R13.10 (unspecified). Never code R13.1- alone if it is known to be a sequela of a stroke.

🔍 Code Description

ICD-10 CM I69.391 classifies dysphagia (difficulty swallowing) that persists or develops as a long-term neurological deficit (sequela) secondary to a previous cerebral infarction (ischemic stroke).

This code signifies that the acute phase of the stroke has passed, but the patient continues to experience swallowing dysfunction, requiring ongoing management, dietary modifications, or speech-language pathology (SLP) intervention. It is a critical code to support the medical necessity of modified barium swallow studies (MBS) and swallowing therapy.

Acute vs. Sequela

Category I69 codes are strictly used for sequelae (late effects). Do not use I69.391 during the initial, acute inpatient admission for the stroke. During the acute phase, you simply code the acute stroke (e.g., I63.50) and the acute symptom of dysphagia (R13.1-). [[I69.391]] is used for subsequent encounters or rehab admissions once the stroke is considered “old” or historical.

🌳 Code Tree / Hierarchy

I69 Sequelae of cerebrovascular disease ❌ Non-billable
│  
├── I69.3 Sequelae of cerebral infarction ❌ Non-billable
│ │  
│ ├── I69.39 Other sequelae of cerebral infarction ❌ Non-billable
│ │ │  
│ │ ├── I69.390 Apraxia following cerebral infarction
│ │ ├── I69.391 DYSPHAGIA FOLLOWING CEREBRAL INFARCTION ◀ THIS CODE ✅
│ │ ├── I69.392 Facial weakness following cerebral infarction
│ │ └── I69.398 Other sequelae of cerebral infarction

✅ Includes

The following clinical scenarios and terms map to I69.391:

  • Dysphagia due to old ischemic stroke (CVA)
  • Difficulty swallowing as a late effect of a cerebral infarction
  • Swallowing disorder following a documented ischemic cerebrovascular accident

❌ Excludes

Excludes1 — Cannot be coded together

The Excludes1 note dictates that the following conditions cannot be coded alongside I69.391. They represent either acute conditions or different etiologies for the dysphagia:

  • Dysphagia during the acute phase of a stroke (code the acute stroke I63.- and R13.1- instead)
  • Sequelae of nontraumatic intracerebral hemorrhage (I69.191) (Must match the exact stroke type!)
  • Sequelae of nontraumatic subarachnoid hemorrhage (I69.091)
  • Psychogenic dysphagia (F45.8)

🛠️ CPT Procedural Crosswalk — wRVU & Assistant Payable Status

Patients with I69.391 are frequently referred to Speech-Language Pathologists (SLPs) and Otolaryngologists/Radiologists for diagnostic imaging and rehabilitative therapy.

CPT CodeDescriptionGlobal PeriodwRVU (Facility)Asst. Surgeon Payable?Bundling & NCCI Edits
92610Evaluation of oral and pharyngeal swallowing functionXXX~1.50No (Indicator 0)Typically performed by SLP. Cannot be billed on the same day as motion fluoroscopy without a modifier.
92611Motion fluoroscopic evaluation of swallowing function by cine or video recording (e.g., MBS)XXX~1.60No (Indicator 0)Billed by the SLP conducting the test. Mutually exclusive with 92612 (FEES) on the same date.
74230Radiologic examination, swallowing function, with cineradiography/videoXXX~0.40 (26)No (Indicator 0)Usually billed by the Radiologist performing the imaging portion of the MBS alongside the SLP’s 92611.
92526Treatment of swallowing dysfunction and/or oral function for feedingXXX~0.50No (Indicator 0)Timed or untimed depending on payer (usually untimed per session). Standard SLP therapy code.

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

💊 Coding Scenarios

Scenario 1 — Modified Barium Swallow (MBS) Study

Clinical Vignette: A 75-year-old male with a history of an ischemic stroke two years ago is referred to the hospital’s outpatient radiology/SLP clinic because he has started coughing while drinking thin liquids. The SLP and Radiologist conduct a motion fluoroscopic swallowing evaluation. The study reveals penetration of thin liquids during the oropharyngeal phase, confirming stroke-related oropharyngeal dysphagia.

CPT / HCPCS:

  • 92611 — Motion fluoroscopic evaluation of swallowing function (SLP’s professional service)
  • 74230-26 — Radiologic exam, swallowing function (Radiologist’s professional interpretation)

ICD-10-CM:

  • I69.391 — Dysphagia following cerebral infarction (Primary code indicating etiology)
  • R13.12 — Dysphagia, oropharyngeal phase (Mandatory secondary code indicating the exact phase of dysphagia)

Scenario 2 — Dysphagia Therapy Session

Clinical Vignette: A 68-year-old female presents to the speech-language pathology clinic for her weekly swallowing therapy. She has unspecified post-stroke dysphagia secondary to a left middle cerebral artery infarct 6 months ago. The therapist spends 45 minutes performing compensatory strategy training and swallowing exercises.

CPT / HCPCS:

  • 92526 — Treatment of swallowing dysfunction and/or oral function for feeding

ICD-10-CM:

  • I69.391 — Dysphagia following cerebral infarction (Primary diagnosis)
  • R13.10 — Dysphagia, unspecified (Secondary code required by guidelines since specific phase wasn’t noted today)

⚠️ Coding Pitfalls and Tips

Pitfall or Tip
❌Do not forget the second code: The most common coding error with I69.391 is forgetting to append the R13.1- code. The ICD-10 tabular list specifically instructs: “Use additional code to identify the type of dysphagia.”
❌Verify the stroke etiology: Do not use I69.391 if the historical stroke was a hemorrhage. You must cross-reference the patient’s history. Subarachnoid hemorrhage uses I69.091; intracerebral hemorrhage uses I69.191.
✅You CAN mix acute and history codes if the patient has a NEW stroke: If a patient who has existing dysphagia from an old stroke (I69.391) is admitted today for a brand new acute stroke (I63.-), you can code both. The I69 code captures the baseline historical deficit, while I63 captures the acute event.
✅Look for Aspiration Pneumonia: If the patient is admitted for aspiration pneumonia (J69.0), look through the record to see if they have a history of stroke causing dysphagia. Linking the aspiration pneumonia back to I69.391 + R13.1- as secondary diagnoses paints an accurate picture of medical complexity.

📚 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 Local Coverage Determinations (LCD) for Speech-Language Pathology and Swallowing Studies (e.g., A56621).

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