🧬 ICD-10 CM I61.8 — Other Nontraumatic Intracerebral Hemorrhage
Billable Code Confirmed
ICD-10 CM I61.8 is a valid, billable, 5-character ICD-10-CM code effective FY2016 through FY2026 with no changes to its structure or status. It represents the “other specified” subcategory within I61 — Nontraumatic intracerebral hemorrhage — capturing bleeding inside the brain parenchyma at locations that do not fit any of the explicitly defined site-specific codes (I61.0-I61.6). This code is appropriate when imaging or clinical documentation confirms a nontraumatic intracerebral hemorrhage but the location is atypical, not otherwise classified, or falls outside the defined anatomical categories of the sibling codes.
Non-Billable Parent Code
I61 — Nontraumatic intracerebral hemorrhage — is the non-billable 3-character parent category header. It cannot be submitted on a claim because it lacks the 4th or 5th character required to indicate hemorrhage location or “other/unspecified” specificity. Assigning I61 without the additional character will result in a claim edit or rejection under current HIPAA transaction standards.
Clinical Context
ICD-10 CM I61.8 is selected specifically when the treating provider or radiologist documents a nontraumatic intracerebral hemorrhage at a location that is definitively not subcortical hemisphere (I61.0), cortical hemisphere (I61.1), unspecified hemisphere (I61.2), brain stem (I61.3), cerebellum (I61.4), intraventricular (I61.5), or multiple localized sites (I61.6). Classic examples include thalamic hemorrhage, lacunar hemorrhage, posterior fossa hemorrhage not specified as cerebellar, and cerebromeningeal hemorrhage. The clinical documentation and imaging report must support the “other specified” designation — coders should not default to I61.8 without confirming the hemorrhage location is truly outside the defined categories.
Code Classification
ICD-10 CM I61.8 is a diagnosis code — it classifies a disease condition and is used on facility UB-04 claims, professional 1500 claims, and encounters. It is not a procedure code and should always be paired with appropriate procedure codes (CPT/ICD-10-PCS) when operative or interventional management occurs. As a diagnosis, it drives DRG assignment, HCC risk adjustment, quality measure attribution, and clinical documentation integrity queries.
🔍 Code Description
ICD-10 CM I61.8 classifies spontaneous (nontraumatic) bleeding within the brain parenchyma that occurs at a location not captured by the site-specific codes I61.0 through I61.6. The “other specified” designation means the hemorrhage location is known and documented but falls outside the standard anatomical categories recognized by the tabular list — this is a critical distinction from I61.9 (unspecified), which is used only when the hemorrhage location truly cannot be determined. Pathophysiologically, these hemorrhages most commonly result from I10 hypertension-driven small vessel rupture, cerebral amyloid angiopathy, arteriovenous malformation rupture, or coagulopathy-related bleeding. The brain parenchyma sustains direct tissue destruction at the hemorrhage site, and surrounding tissue undergoes secondary injury from edema, mass effect, and toxic effects of blood breakdown products, producing the neurological deficits seen clinically.
From a documentation and coding integrity standpoint, the index entry cross-references for I61.8 include intracerebral anastomosis hemorrhage, intraparenchymal hemorrhage, thalamic hemorrhage, lacunar hemorrhage, cerebromeningeal hemorrhage, posterior fossa hemorrhage NEC, and hemorrhagic cerebral infarction (other specified). Because I61.8 maps to HCC 248 under CMS-HCC V28 with a RAF weight of 0.239, it carries significant risk adjustment impact and must meet MEAT documentation standards at every encounter to count toward the patient’s annual risk score. Coders working inpatient should also apply the instructional note at the I61 category level: “Use additional code, if known, to indicate National Institutes of Health Stroke Scale (NIHSS) score (R29.7-)” — NIHSS score capture is a CDI best practice and supports severity documentation for DRG optimization.
🌳 Code Tree / Hierarchy
I60-I69 Cerebrovascular diseases ❌ Non-billable (block header)
│
├── I60 Nontraumatic subarachnoid hemorrhage ❌ Non-billable (category header)
│ ├── I60.0x Nontraumatic SAH from carotid siphon and bifurcation ✅ Billable
│ └── I60.9 Nontraumatic subarachnoid hemorrhage, unspecified ✅ Billable
│
├── I61 Nontraumatic intracerebral hemorrhage ❌ Non-billable (category header)
│ ├── I61.0 Nontraumatic ICH in hemisphere, subcortical ✅ Billable
│ ├── I61.1 Nontraumatic ICH in hemisphere, cortical ✅ Billable
│ ├── I61.2 Nontraumatic ICH in hemisphere, unspecified ✅ Billable
│ ├── I61.3 Nontraumatic ICH in brain stem ✅ Billable
│ ├── I61.4 Nontraumatic ICH in cerebellum ✅ Billable
│ ├── I61.5 Nontraumatic ICH, intraventricular ✅ Billable
│ ├── I61.6 Nontraumatic ICH, multiple localized ✅ Billable
│ ├── I61.8 Other nontraumatic intracerebral hemorrhage ◀ THIS CODE ✅ Billable
│ └── I61.9 Nontraumatic intracerebral hemorrhage, unspecified ✅ Billable
│
└── I62 Other and unspecified nontraumatic intracranial hemorrhage ❌ Non-billable (category header)
├── I62.0x Nontraumatic subdural hemorrhage ✅ Billable (with 5th character)
├── I62.1 Nontraumatic extradural hemorrhage ✅ Billable
└── I62.9 Nontraumatic intracranial hemorrhage, unspecified ✅ Billable"Other Specified" vs. "Unspecified" — This Distinction Gets Audited
ICD-10 CM I61.8 is “other specified” — the location is known but doesn’t fit a defined category; I61.9 is “unspecified” — the location is genuinely unknown or undocumented. Payers and RAC auditors flag I61.9 as a documentation integrity concern because most imaging-confirmed hemorrhages have an identifiable location, and defaulting to unspecified when the record supports specificity is a coding compliance risk. When the location is documented as thalamic, lacunar, or posterior fossa NEC, I61.8 is correct — a provider query should be initiated if documentation is vague.
Tip
Always review the CT or MRI radiology report directly when coding I61.8 — the radiologist’s description of hemorrhage location is the primary driver of code selection within the I61.x family. If the radiology report identifies the hemorrhage in the subcortex, cortex, brain stem, cerebellum, ventricles, or multiple localized sites, a more specific sibling code applies and I61.8 would be incorrect. Document your code selection rationale in your coding worksheet, especially if a provider query was generated.
✅ Includes
The ICD-10-CM tabular list does not publish formal Includes notes at the I61.8 code level for FY2026. The following terms are recognized index-to-disease cross-references that appropriately map to I61.8:
- Cerebromeningeal hemorrhage — bleeding involving both the cerebral tissue and the meningeal interface at an atypical location
- Intraparenchymal hemorrhage — spontaneous hemorrhage within the brain tissue substance without a documented site falling under [[I61.0]]-I61.6
- Lacunar hemorrhage — small vessel hemorrhage in the deep brain structures (e.g., basal ganglia, thalamus, internal capsule) when the specific thalamic designation is used or location is otherwise atypical
- Thalamic hemorrhage — direct index reference to I61.8; thalamic location does not map to subcortical (I61.0) or cortical (I61.1) hemisphere codes
- Posterior fossa hemorrhage NEC — when not cerebellar (I61.4) and not brain stem (I61.3), posterior fossa hemorrhage indexes to I61.8
- Hemorrhagic cerebral infarction (other specified) — infarction with hemorrhagic conversion at a location outside defined categories maps here per the index
❌ Excludes
Excludes 1
The ICD-10-CM tabular list for FY2026 does not publish Excludes 1 notes at the I61.8 code level. There are no mutually exclusive codes that cannot be reported simultaneously with I61.8 under the current tabular guidance. Coders should note that traumatic intracerebral hemorrhage codes (S06.3x-) are a separate code set entirely and represent a distinct etiological category — trauma-related hemorrhage must never be coded to I61.x, as the “nontraumatic” designation is definitional.
Danger
The most critical exclusion error with I61.8 is assigning it to a traumatic intracerebral hemorrhage. If the mechanism of injury is documented (falls, MVA, assault, etc.) and clinical causation is attributed to trauma, the correct codes are in the S06.3x- family (Traumatic hemorrhage of cerebrum) with appropriate external cause codes — not I61.8. Applying I61.8 to a traumatic hemorrhage constitutes a coding error that can affect payer adjudication, MS-DRG assignment, and create compliance exposure, especially under RAC and MAC audits.
Excludes 2
- I69.1- — Sequelae of nontraumatic intracerebral hemorrhage. These codes represent the late effects or residual conditions that persist after the acute hemorrhagic event has resolved. I69.1- codes can be reported separately from I61.8 when a patient presents with both an acute hemorrhage (I61.8) and residual neurological deficits from a prior separate hemorrhagic event — they are not mutually exclusive and represent different episodes of care or concurrent conditions.
📋 Clinical Overview
Intracerebral Hemorrhage Location-Based Code Selection
Selecting the correct I61.x code requires accurate mapping of the documented hemorrhage location to the ICD-10-CM anatomical categories. The imaging report is the authoritative source, and coders must be familiar with neuroanatomical terminology to assign with confidence. I61.8 is a residual “other specified” category and should never be a default — it requires affirmative confirmation that the location is outside I61.0-I61.6.
| Feature | I61.8 | I61.0 | I61.4 |
|---|---|---|---|
| Location | Atypical or unclassified parenchymal site (thalamus, posterior fossa NEC, lacunar, cerebromeningeal) | Deep white matter, basal ganglia, internal capsule — subcortical hemisphere | Cerebellar hemisphere or vermis |
| Common Etiology | HTN, AVM rupture, amyloid angiopathy (atypical sites), lacunar disease | HTN-related hypertensive hemorrhage most common; small vessel disease | HTN, AVM, cavernous malformation |
| HCC Mapping (V28) | HCC 248 — RAF 0.239 | HCC 248 — RAF 0.239 | HCC 248 — RAF 0.239 |
| DRG Impact | DRG 064/065/066 based on CC/MCC | DRG 064/065/066 based on CC/MCC | DRG 064/065/066 based on CC/MCC |
| CDI Focus | Confirm “other” location is truly outside I61.0-I61.6; query for thalamic/lacunar specificity | Confirm subcortical vs. cortical location; basal ganglia hemorrhage is subcortical | Confirm cerebellar involvement on imaging; posterior fossa NEC routes to I61.8 |
Important
CDI trigger: When the attending documents “intracerebral hemorrhage” without specifying location, issue a query to confirm whether the hemorrhage is subcortical, cortical, brain stem, cerebellar, intraventricular, multiple localized, or another/atypical location. Without location specificity, you are forced into I61.9 (unspecified), which, while still HCC-mapped, represents a documentation gap that payers and auditors will flag. Location specificity is not just a coding nicety — it directly supports medical necessity, care intensity, and quality reporting.
Manifestations & Symptom Burden
- Sudden severe headache — “thunderclap” presentation common with rapidly expanding hemorrhage; supports neurological consult documentation
- Focal neurological deficits — contralateral hemiplegia, hemisensory loss, aphasia, or hemianopia depending on hemorrhage location; manifestation codes (e.g., G81.90 hemiplegia, unspecified) may be reportable as secondary diagnoses when documented as clinically significant
- Altered level of consciousness — ranges from confusion to coma depending on hemorrhage volume and location; supports MCC capture (e.g., R40.20 unspecified coma) if documented
- Dysphagia — common sequela of hemispheric or brain stem involvement; R13.10 or more specific dysphagia code reportable as secondary diagnosis
- Increased intracranial pressure / herniation — life-threatening complication; G93.5 compression of brain is reportable when documented and may elevate to MCC status
Tip
Manifestation coding for intracerebral hemorrhage follows the standard guideline that signs and symptoms integral to the condition are not separately reportable — but when a complication or associated condition is distinctly documented and clinically managed (e.g., dysphagia requiring speech therapy consult, hemiplegia driving PT/OT involvement), it absolutely should be coded. The NIHSS score (R29.7-) instructional note at I61 is your best friend for supporting severity on these cases — capture it every time it’s documented because it strengthens medical necessity, informs DRG logic, and is required for certain quality programs.
💰 HCC Risk Adjustment
| Model | HCC | Category Label | Base RAF (Community, Non-Dual, Aged) |
|---|---|---|---|
| CMS-HCC V28 | HCC 248 | Intracranial Hemorrhage | 0.239 |
| CMS-HCC V24 | HCC 99 | Intracranial Hemorrhage | 0.230 |
| ESRD/PACE | HCC 99 | Intracranial Hemorrhage | 0.000 |
| ACA/HHS | N/A | Not mapped | 0.000 |
ICD-10 CM I61.8 maps to HCC 248 under CMS-HCC V28, the model now at 100% phase-in for payment year 2026. The base RAF of 0.239 reflects a meaningful risk adjustment contribution, acknowledging the clinical severity and resource intensity associated with intracerebral hemorrhage. Because V28 is fully phased in, payers are no longer blending V24 and V28 weights, making accurate HCC capture under V28 the only model that matters for PY2026 MA plan submissions. For MEAT compliance, documentation must show the provider is actively monitoring, evaluating, assessing, or treating the hemorrhage during the encounter — copy-forward problem list entries alone do not satisfy HCC capture requirements under CMS audit standards. For inpatient facility coding, risk adjustment is relevant for MA plans whose reimbursement is retrospectively reconciled using hospital encounter data; always ensure the code is reported on the UB-04 to feed into encounter data submissions.
🏥 MS-DRG Assignment
| DRG | Title | CC/MCC Requirement |
|---|---|---|
| DRG 064 | Intracranial Hemorrhage or Cerebral Infarction with MCC or tPA in 24 Hours | With MCC or tPA within 24h |
| DRG 065 | Intracranial Hemorrhage or Cerebral Infarction with CC | With CC, no MCC |
| DRG 066 | Intracranial Hemorrhage or Cerebral Infarction without CC/MCC | No CC or MCC |
ICD-10 CM I61.8 as the principal diagnosis sequences directly to MDC 01 (Diseases and Disorders of the Nervous System) and drives grouping within the DRG 064-066 triplet. DRG 064 carries the highest relative weight and is triggered either by a qualifying MCC (such as acute respiratory failure, coma, or sepsis) or by documented tPA administration within 24 hours of admission — coders must review pharmacy records for tPA use independent of CC/MCC status. Common MCC opportunities include: J96.00 acute respiratory failure, R40.20 unspecified coma, I46.9 cardiac arrest, and pressure ulcers at stage 3 or 4. Sequencing discipline is critical — I61.8 should be the principal diagnosis when the hemorrhage was the condition established after study to be chiefly responsible for admission; if the admission was driven by a complication (e.g., airway compromise), sequencing logic must be re-evaluated with the coding team and CDI specialist. Always verify that the attending’s clinical documentation supports the CC/MCC code, not just a problem list reference, to withstand a RAC or MAC audit.
🔗 Related ICD-10-CM Codes
Intracerebral & Intracranial Hemorrhage Family
- I61.0 — Nontraumatic intracerebral hemorrhage in hemisphere, subcortical
- I61.1 — Nontraumatic intracerebral hemorrhage in hemisphere, cortical
- I61.2 — Nontraumatic intracerebral hemorrhage in hemisphere, unspecified
- I61.3 — Nontraumatic intracerebral hemorrhage in brain stem
- I61.4 — Nontraumatic intracerebral hemorrhage in cerebellum
- I61.5 — Nontraumatic intracerebral hemorrhage, intraventricular
- I61.6 — Nontraumatic intracerebral hemorrhage, multiple localized
- I61.9 — Nontraumatic intracerebral hemorrhage, unspecified
- I62.9 — Nontraumatic intracranial hemorrhage, unspecified
- I62.1 — Nontraumatic extradural hemorrhage
Associated Conditions, Complications & Sequelae
- I10 — Essential (primary) hypertension (most common underlying etiology; code additionally)
- I69.10 — Unspecified sequelae of nontraumatic intracerebral hemorrhage
- R29.700 — NIHSS score 0 (use additional code per I61 instructional note)
- G81.90 — Hemiplegia, unspecified, affecting unspecified side (reportable manifestation)
- R13.10 — Dysphagia, unspecified (reportable associated condition when documented)
- G93.5 — Compression of brain (reportable complication when documented; possible MCC)
- J96.00 — Acute respiratory failure, unspecified (MCC when documented)
- Q28.2 — Arteriovenous malformation of cerebral vessels (underlying etiology if documented)
🛠️ Commonly Associated CPT Codes
- 61315 — Craniectomy or craniotomy for evacuation of intracerebral hematoma, supratentorial; intracerebral. This is the primary surgical intervention for supratentorial intracerebral hemorrhage requiring operative evacuation; modifier -22 may apply for increased procedural complexity in large or eloquent-area hematomas. Report alongside I61.8 when the hematoma location is supratentorial and atypical.
- 61312 — Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural or subdural. Distinguish carefully from 61315 — this code is for extradural/subdural hematomas, not intracerebral; applicable only if a co-existing extradural or subdural component is separately evacuated.
- 61322 — Craniectomy or craniotomy for evacuation of hematoma, infratentorial or posterior fossa; extradural or subdural. Relevant when I61.8 represents a posterior fossa hemorrhage with a subdural component requiring infratentorial evacuation.
- 61323 — Craniectomy or craniotomy for evacuation of hematoma, infratentorial or posterior fossa; intracerebral. This is the counterpart to 61315 for infratentorial/posterior fossa intracerebral hemorrhage — directly applicable when I61.8 represents a posterior fossa NEC or other infratentorial hemorrhage requiring operative management.
- 99233 — Subsequent hospital inpatient care, high complexity (E/M). Routine inpatient management of I61.8 will generate daily subsequent hospital E/M services billed by the attending; MDM-based coding under 2023+ E/M guidelines typically supports 99232 or 99233 depending on documented complexity and management decisions.
- 95819 — Electroencephalogram (EEG), awake and asleep. EEG is frequently ordered in intracerebral hemorrhage patients to monitor for seizure activity, which is a common complication; if seizures develop, add G40.909 or appropriate seizure code as an additional diagnosis.
NCCI Bundling Considerations
Surgical evacuation codes (61315, 61323) bundle with many diagnostic imaging guidance codes when performed in the same operative session — review NCCI edits before appending separate radiology supervision and interpretation codes. Intraoperative neuromonitoring (95940, 95941) is generally separately reportable but may require a modifier -59 or -XU to bypass certain NCCI pairs depending on payer. Postoperative E/M services within the global surgical period of a craniotomy code (90-day global) are bundled and should not be billed separately by the performing surgeon unless the service is unrelated to the operative diagnosis or a significant, separately identifiable E/M is documented with modifier -24.
🔬 ICD-10-PCS Crosswalk
- 00C00ZZ — Extirpation of Matter from Brain, Open Approach. Used when the operative report documents open craniotomy/craniectomy for evacuation of the intracerebral hematoma; root operation is Extirpation (taking or cutting out solid matter) from the Brain body part. This is the most common ICD-10-PCS code paired with I61.8 when surgical evacuation is performed.
- 00C03ZZ — Extirpation of Matter from Brain, Percutaneous Approach. Applicable when stereotactic or minimally invasive aspiration of the hematoma is performed via a burr hole or catheter-based percutaneous technique rather than open craniotomy. Confirm approach documentation in the operative report before selecting between 00C00ZZ and 00C03ZZ.
- B030YZZ — Fluoroscopy of Intracranial Arteries using Other Contrast. May be applicable when cerebral angiography is performed to evaluate for underlying vascular etiology (AVM, aneurysm) contributing to the hemorrhage.
- 30230N1 — Transfusion of Nonautologous Red Blood Cells into Peripheral Vein, Percutaneous. Applicable when blood product transfusion is required due to anemia or hemorrhage-related hemodynamic compromise; code separately per ICD-10-PCS guidelines when the procedure is performed and documented.
💊 Coding Scenarios and Examples
Scenario 1 — Thalamic Hemorrhage with Hypertension, No Surgery A 67-year-old Medicare Advantage patient presents with acute onset left-sided hemiplegia and confusion. MRI confirms a thalamic hemorrhage. The attending documents hypertensive intracerebral hemorrhage, thalamic location, with acute left-sided hemiplegia. NIHSS score documented as 14.
- Principal Dx: I61.8 — Other nontraumatic intracerebral hemorrhage (thalamic = other specified per index)
- Secondary: I10 — Essential (primary) hypertension
- Secondary: G81.94 — Hemiplegia, unspecified, affecting left nondominant side
- Secondary: R29.714 — NIHSS score 14
- DRG Sequencing: Sequences to DRG 065 or 066 depending on whether hemiplegia qualifies as CC in this grouper version — confirm with your grouper. Hypertension alone is not a CC/MCC. NIHSS capture is a quality and documentation win. CDI note: Query if acute respiratory complications or altered consciousness is documented elsewhere in the record — may elevate to DRG 064.
Scenario 2 — Posterior Fossa Hemorrhage with Surgical Evacuation A 55-year-old with known AVM presents with sudden severe headache and cerebellar signs. CT confirms a posterior fossa hemorrhage not involving the cerebellum directly (vermis excluded on imaging); neurosurgery performs an open posterior fossa craniotomy for hematoma evacuation.
- Principal Dx: I61.8 — Other nontraumatic intracerebral hemorrhage (posterior fossa NEC, not cerebellar = other specified)
- Secondary: Q28.2 — Arteriovenous malformation of cerebral vessels (underlying etiology)
- ICD-10-PCS: 00C00ZZ — Extirpation of Matter from Brain, Open Approach
- DRG Sequencing: With Q28.2 as a CC, this case likely groups to DRG 065. CDI note: If the patient required ICU monitoring, post-op respiratory support, or developed complications, query the attending for MCC-level documentation to capture DRG 064.
Scenario 3 — Concurrent Acute Hemorrhage and Sequelae of Prior Hemorrhage A 72-year-old with a history of prior intracerebral hemorrhage with residual right hemiparesis presents with a new intracerebral hemorrhage at an atypical location (lacunar, deep periventricular white matter not fitting subcortical basal ganglia pattern).
- Principal Dx: I61.8 — Other nontraumatic intracerebral hemorrhage (new, acute event)
- Secondary: I69.151— Hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage affecting right dominant side (residual from prior event — Excludes 2 note allows concurrent coding)
- Secondary: I10 — Hypertension
- DRG Sequencing: Principal diagnosis drives MDC 01 and DRG 064/065/066 grouping; I69.151 as a secondary may function as a CC depending on grouper. CDI note: Document new vs. prior hemorrhage clearly in the H&P — “new lacunar hemorrhage” vs. “sequelae of prior ICH” must be explicitly differentiated in the record to support dual code assignment.
⚠️ Coding Pitfalls and Tips
- Do not default to I61.8 without checking I61.0-I61.6 first. I61.8 is an “other specified” code — it requires confirmation that the hemorrhage location is outside all defined categories. A subcortical hemorrhage coded as I61.8 instead of I61.0 is a specificity error that could be flagged on audit.
- ICD-10 CM I61.8 ≠ I61.9. “Other specified” (I61.8) means the location is known but atypical; “unspecified” (I61.9) means the location cannot be determined. Assigning I61.9 when the radiology report documents a specific location is a documentation-driven coding error — always query if ambiguous.
- Always apply the Use Additional Code note for NIHSS (R29.7-). This instructional note applies at the I61 category level and is therefore applicable to I61.8. NIHSS score capture supports severity, medical necessity, quality programs, and CDI initiatives — don’t skip it when it’s in the chart.
- Verify nontraumatic etiology before assigning I61.8. If there is any documented mechanism of trauma, the correct code family is S06.3x- (Traumatic hemorrhage of cerebrum). Assigning I61.8 to a traumatic hemorrhage is a serious coding error with compliance and reimbursement implications.
- Thalamic hemorrhage indexes directly to I61.8 — this is one of the most common “other specified” locations you’ll encounter on neuro cases. When the radiologist or neurologist documents thalamic hemorrhage, go directly to I61.8; do not code it as subcortical (I61.0) — the thalamus is a deep gray matter structure, not white matter subcortex, and the index is explicit.
- Capture comorbidities aggressively for DRG optimization. Conditions like acute respiratory failure (J96.00), coma (R40.20), compression of brain (G93.5), and severe sepsis can elevate the case to DRG 064 — the highest-weighted DRG in this triplet. CDI collaboration on I61.8 cases is high yield; a single MCC query can mean a significant relative weight difference.