🧬 ICD-10 CM I67.82 — Cerebral Ischemia
Billable Code Confirmed
ICD-10 CM I67.82 is a valid, fully billable 5-character ICD-10-CM code for FY2026, classified under the I67 category of Other Cerebrovascular Diseases. The 5th character “2” specifies cerebral ischemia within the I67.8 (Other specified cerebrovascular diseases) subcategory, confirming full code specificity. No additional characters are required for billing.
Non-Billable Parent Codes
I67 — Other cerebrovascular diseases ❌ Non-billable; serves as the category-level header and requires a 4th or 5th character for specificity. I67.8 — Other specified cerebrovascular diseases ❌ Non-billable; this subcategory header requires a 5th character (e.g., I67.81, I67.82, I67.83, I67.89) to reach billable status. Neither I67 nor I67.8 should ever appear on a claim as a standalone code.
Clinical Context
ICD-10 CM I67.82 specifically captures chronic or established cerebral ischemia — the sustained reduction in cerebral blood flow that does not meet the threshold of an acute cerebral infarction (I63.x). This distinction is clinically and coding-critical: the provider documentation must reflect ongoing or chronic hypoperfusion, not an acute stroke event. When the clinical record suggests an acute ischemic event with infarction, the Excludes 1 note mandates the use of I63.x codes instead.
Code Classification
ICD-10 CM I67.82 is a diagnosis code — ICD-10-CM, Chapter 9 (Diseases of the Circulatory System). It is not a procedure code (CPT, HCPCS, or ICD-10-PCS) and must never be used in the procedure field of a claim. This code represents a cerebrovascular disease state, not a manifestation, complication, or external cause.
🔍 Code Description
ICD-10 CM I67.82 classifies cerebral ischemia, which refers to insufficient blood supply to the brain resulting in oxygen and glucose deprivation to cerebral tissue. This condition is most commonly associated with atherosclerosis of the cerebral or carotid arteries, hypertension (I10), small vessel disease, and cardiac arrhythmia such as atrial fibrillation (I48.x). Unlike an acute ischemic stroke (I63.x), I67.82 captures the chronic or non-infarctive form of cerebral ischemia, where blood flow is reduced but has not yet resulted in confirmed tissue death or infarction. The condition is frequently identified on imaging studies (MRI/MRA) as white matter changes, periventricular leukoaraiosis, or diffuse small vessel ischemic changes without focal infarction.
Clinically, patients with chronic cerebral ischemia present with a spectrum of symptoms including cognitive impairment, vascular dementia (F01.x), gait disturbances, and focal neurological deficits that fluctuate without progressing to confirmed stroke. The code is frequently encountered in inpatient neurology and geriatric admissions where chronic hypoperfusion contributes to the primary admission but is not itself the infarctive event. Coders must closely review the provider’s clinical language — terms such as “cerebral hypoperfusion,” “chronic small vessel ischemic disease,” or “chronic cerebral ischemia” all index to I67.82 in the ICD-10-CM Alphabetic Index. Pairing I67.82 with hypertensive cerebrovascular disease (I67.4) or cerebral atherosclerosis (I67.2) is appropriate when both conditions are documented and clinically relevant.
🌳 Code Tree / Hierarchy
I67 Other cerebrovascular diseases ❌ Non-billable
│
├── I67.0 Dissection of cerebral arteries, nonruptured ✅ Billable
├── I67.1 Cerebral aneurysm, nonruptured ✅ Billable
├── I67.2 Cerebral atherosclerosis ✅ Billable
├── I67.3 Progressive vascular leukoencephalopathy ✅ Billable
├── I67.4 Hypertensive encephalopathy ✅ Billable
├── I67.5 Moyamoya disease ✅ Billable
├── I67.6 Nonpyogenic thrombosis of intracranial venous system ✅ Billable
├── I67.7 Cerebral arteritis, not elsewhere classified ✅ Billable
│
├── I67.8 Other specified cerebrovascular diseases ❌ Non-billable
│ │
│ ├── I67.81 Acute cerebrovascular insufficiency ✅ Billable
│ ├── I67.82 Cerebral ischemia ◀ THIS CODE ✅ Billable
│ ├── I67.83 Posterior reversible encephalopathy syndrome ✅ Billable
│ ├── I67.841 Reversible cerebrovascular vasoconstriction syndrome ✅ Billable
│ ├── I67.848 Other cerebrovascular vasospasm and vasoconstriction ✅ Billable
│ └── I67.89 Other cerebrovascular disease ✅ Billable
│
└── I67.9 Cerebrovascular disease, unspecified ✅ Billable
Specificity Matters: I67.82 vs. I67.81 vs. I63.x
ICD-10 CM I67.81 (Acute cerebrovascular insufficiency) is used when the provider documents an acute episode of reduced cerebral blood flow without infarction, whereas I67.82 is reserved for the chronic state. If the provider documents cerebrovascular insufficiency without specifying acute vs. chronic, query for clarification — the distinction affects both DRG grouping and clinical documentation integrity.
Tip
ICD-10 CM I67.82 does not have an Excludes 1 for I67.2 (Cerebral atherosclerosis) — both may be coded together when documented. Always check the full medical record for contributory diagnoses like atherosclerosis (I67.2) or hypertension (I10) that can be captured as additional codes, potentially impacting CC/MCC-driven DRG weight.
✅ Includes
- Chronic cerebral ischemia — This is the only explicit inclusion term listed for ICD-10 CM I67.82 in the ICD-10-CM tabular. It confirms that the code is appropriate when the provider documents chronicity of the cerebral ischemic process, distinguishing it from the acute variant at I67.81.
❌ Excludes
Excludes 1
I63.3—I63.5- — Occlusion and stenosis of cerebral artery causing cerebral infarction — This is a hard Excludes 1, meaning I67.82 and I63.3x -I63.5x cannot be coded on the same claim for the same encounter. If imaging or clinical documentation confirms cerebral infarction as the result of vessel occlusion or stenosis, the I63.x code is required and I67.82 must not be assigned. The clinical distinction turns on whether infarction (tissue death) is confirmed — if it is, I63.x wins.
I63.2- — Occlusion and stenosis of precerebral artery causing cerebral infarction — Also a hard Excludes 1 with I67.82. Precerebral artery occlusion (carotid, vertebral, basilar) that has resulted in confirmed infarction codes to I63.2-, not I67.82. Coders should review radiology reports carefully; the word “ischemia” in an MRI report does not automatically mean I67.82 if focal infarction is also described.
Danger
The most common Excludes 1 error with I67.82 is assigning it concurrently with an acute I63.x code on the same claim when the provider documents both “cerebral ischemia” and “acute cerebral infarction.” Per the Excludes 1 instruction, if infarction is confirmed, I63.x is the required code and I67.82 is excluded. Querying the provider about whether the ischemia represents a chronic background finding versus the acute event is essential for defensible coding.
Excludes 2
I69.8x — Sequelae of other and unspecified cerebrovascular diseases — This is an Excludes 2, meaning it can be coded in addition to I67.82 when the patient has residual neurological deficits from a prior cerebrovascular event AND is now also experiencing chronic cerebral ischemia as a current condition. When both are documented as distinct conditions contributing to the patient’s care, both codes are appropriate. Document the clinical relationship clearly in the query or CDI note to support dual coding.
📋 Clinical Overview
Chronic Cerebral Ischemia vs. Acute Events: Code Selection Guide
Chronic cerebral ischemia (I67.82) sits in a clinically nuanced space between a patient’s first stroke (I63.x) and their post-stroke sequelae (I69.x). It most commonly presents in elderly patients with multiple vascular risk factors whose MRI shows diffuse white matter changes without discrete infarct. Providers may document it as “chronic ischemic changes,” “chronic small vessel disease,” or “cerebral hypoperfusion,” all of which index to I67.82. Coders must critically assess the full clinical picture to distinguish this from an acute or subacute event.
| Feature | I67.82 | I67.81 | I63.9 |
|---|---|---|---|
| Acuity | Chronic, ongoing hypoperfusion without confirmed infarction | Acute episode of cerebrovascular insufficiency, no infarction confirmed | Acute cerebral infarction — tissue death confirmed |
| Imaging finding | Diffuse white matter changes, leukoaraiosis, no focal infarct | May show transient perfusion deficits; no infarct on DWI | Focal DWI-positive lesion confirming infarction |
| HCC mapping (V28) | No HCC mapping — not risk-adjusting under V28 | No HCC mapping — not risk-adjusting under V28 | HCC 249 — RAF 0.239 (community, non-dual, aged) |
| DRG family | DRG 070/071/072 — Other Cerebrovascular Disorders | DRG 070/071/072 — Other Cerebrovascular Disorders | DRG 064/065/066 — Intracranial Hemorrhage or Cerebral Infarction |
| Excludes 1 conflict | Excludes I63.2-I63.5 when infarction confirmed | No Excludes 1 with I67.82 | Mutually exclusive with I67.82 per Excludes 1 note |
Important
CDI Trigger: When the provider documents “cerebral ischemia” in the context of a patient admitted for altered mental status, cognitive decline, or new focal deficits, query whether the ischemia is chronic background (I67.82) vs. a new acute event (I63.x or I67.81). The answer determines DRG grouping, potential HCC capture, and defensibility under payer audit. A query to the attending or neurologist clarifying acuity and whether infarction is confirmed on imaging is well supported here.
Manifestations & Symptom Burden
- Cognitive impairment / Vascular dementia — Chronic cerebral ischemia is a leading driver of vascular cognitive impairment; when the provider documents vascular dementia in the setting of I67.82, code F01.50 (Vascular dementia, unspecified severity, without behavioral disturbance) or the appropriate F01.5x code additionally, as the manifestation should be coded separately.
- Gait disturbance — Small vessel ischemic disease affecting subcortical motor tracts commonly produces a cautious or apractic gait; R26.89 (Other abnormalities of gait and mobility) may be coded as an additional diagnosis when documented.
- Dizziness and vertigo — Chronic posterior circulation ischemia frequently manifests as episodic dizziness; if documented without confirmed infarction, R42 (Dizziness and giddiness) may be reported additionally.
- Focal neurological deficits (transient) — Patients may experience TIA-like episodes; if the provider confirms the episode resolved without infarction and documents it as TIA, G45.9 (Transient cerebral ischemic attack, unspecified) may be more appropriate than I67.82.
- White matter changes / Leukoaraiosis — Radiologic finding commonly associated with I67.82; not separately coded unless the provider explicitly diagnoses a named leukoencephalopathy (e.g., I67.3 — Progressive vascular leukoencephalopathy).
Tip
Manifestation coding with I67.82 follows the general guideline that signs and symptoms integral to the condition are not coded separately — but when a manifestation rises to the level of a separately diagnosable condition (e.g., vascular dementia F01.5x), it should be coded in addition to I67.82. Always check whether the provider has explicitly linked the vascular dementia or cognitive impairment to the cerebral ischemia, as that clinical linkage supports dual coding and may assist CDI in capturing additional secondary diagnoses that affect MS-DRG severity.
💰 HCC Risk Adjustment
| Model | HCC Category | RAF Weight | Phase-In Status |
|---|---|---|---|
| CMS-HCC V28 (PY2026) | Not HCC-mapped | N/A | V28 at 100% phase-in PY2026 |
| CMS-HCC V24 | Not HCC-mapped | N/A | Retired |
ICD-10 CM I67.82 does not map to a payment HCC under the CMS-HCC V28 model in PY2026, which reached full 100% phase-in for payment year 2026. The ischemic stroke category that carries RAF weight under V28 is HCC 249 (Ischemic or Unspecified Stroke), driven by the I63.x code family with a community non-dual aged RAF of 0.239. For Medicare Advantage plans, chronic cerebral ischemia coded alone as I67.82 will generate no incremental RAF score. CDI and risk adjustment coders should flag encounters where I67.82 is the only cerebrovascular code to evaluate whether an underlying completed stroke (I63.x) or documented sequelae (I69.3x → HCC 253, RAF 0.387) should also be captured. When both a prior ischemic infarction and chronic ischemia are documented as separate, coexisting conditions, the I63.x (if still the acute event) or appropriate sequela code would be the HCC driver.
🏥 MS-DRG Assignment
| CC/MCC Status | MS-DRG | Title | FY2026 Relative Weight (approx.) | GMLOS |
|---|---|---|---|---|
| With MCC | 070 | Other Cerebrovascular Disorders with MCC | ~2.0110 | 4.4 |
| With CC | 071 | Other Cerebrovascular Disorders with CC | ~1.1163 | 3.1 |
| Without CC/MCC | 072 | Other Cerebrovascular Disorders without CC/MCC | ~0.7562 | 2.3 |
When I67.82 is the principal diagnosis, it groups to the MS-DRG 070/071/072 family under MDC 01 (Diseases and Disorders of the Nervous System) — a significantly lower relative weight range compared to the DRG 064/065/066 family used for acute ischemic stroke and cerebral infarction (I63.x), where DRG 064 with MCC carries a relative weight of approximately 2.011. Coders should ensure all valid secondary diagnoses are coded and sequenced correctly, as the CC/MCC impact on this DRG family is substantial — the difference between DRG 070 and DRG 072 can represent thousands of dollars in reimbursement. Common MCCs that elevate DRG grouping in this family include respiratory failure (J96.x), sepsis (A41.x), and [[acute kidney injury]] (N17.x). A complete secondary diagnosis sweep reviewing the H&P, progress notes, and consultations is essential to maximize compliant reimbursement on any admission grouped here.
🔗 Related ICD-10-CM Codes
Cerebrovascular Disease — Ischemic Spectrum
- I67.81 — Acute cerebrovascular insufficiency (acute variant; same category, different acuity)
- I67.2 — Cerebral atherosclerosis (frequently co-documented underlying cause)
- I67.4 — Hypertensive encephalopathy (related end-organ cerebrovascular manifestation)
- I63.9 — Cerebral infarction, unspecified (acute ischemic stroke; Excludes 1 conflict — not codeable with I67.82 at same encounter when infarction confirmed)
- G45.9 — Transient cerebral ischemic attack, unspecified (TIA; must distinguish from chronic ischemia)
- I67.3 — Progressive vascular leukoencephalopathy (Binswanger disease; white matter disease on ischemic spectrum)
Manifestation and Sequela Codes
- F01.50 — Vascular dementia, unspecified severity, without behavioral disturbance (common manifestation)
- F01.51 — Vascular dementia, unspecified severity, with behavioral disturbance
- I69.398 — Other sequelae of cerebral infarction (use when post-infarct deficits coexist)
- R41.3 — Other amnesia (may be associated symptom)
- R26.89 — Other abnormalities of gait and mobility (associated functional deficit)
🛠️ Commonly Associated CPT Codes
- 93880 — Duplex scan of extracranial arteries, complete bilateral study — This is one of the most commonly ordered studies in the workup of cerebral ischemia to evaluate carotid and vertebral artery stenosis; 2-3 sentence billing note: Bill with I67.82 when the scan is performed to evaluate the degree of carotid stenosis contributing to chronic cerebral ischemia. Modifier -26 applies when the physician provides only the interpretation in a facility setting. Ensure documentation supports medical necessity linking the duplex scan to the ischemia diagnosis.
- 93886 — Transcranial Doppler study of the intracranial arteries, complete — Used to assess intracranial vessel flow velocities and identify stenosis or vasospasm contributing to cerebral ischemia; supports I67.82 as the diagnosis driving the study. Bilateral studies and complete vs. limited studies (93888) have different CPT codes — select based on what was actually performed and documented. NCCI edits pair this with 93880 — check bundling rules before billing both on the same date.
- 70553 — MRI brain without and with contrast — Brain MRI with and without contrast is the gold-standard imaging study for evaluating white matter ischemic changes associated with I67.82; I67.82 is an appropriate diagnosis code to support medical necessity. In the facility setting, the technical component is billed separately from the professional (radiology) component using modifier -26. Ensure the order and final report both reference cerebral ischemia or chronic ischemic changes.
- 99233 — Subsequent hospital inpatient or observation care, high medical decision making — Subsequent inpatient E&M at high MDM is appropriate for complex cerebrovascular patients admitted with I67.82 as the principal diagnosis in the context of multiple comorbidities. For inpatient profee billing, the MDM must reflect the complexity of data reviewed (imaging, neurology consults, prior records) and the risk of management decisions (antiplatelet, anticoagulation, statin therapy adjustments).
- 96116 — Neurobehavioral status exam, per hour — Neurobehavioral status examination is frequently ordered in the context of I67.82 when cognitive impairment or suspected vascular dementia is documented; the exam supports clinical differentiation of vascular dementia from Alzheimer’s or mixed dementia types. Only a qualified health professional (neurologist, neuropsychologist) may report this; ensure the ordering documentation links back to I67.82 or a companion F01.5x code. At least one hour of face-to-face patient evaluation is required per unit billed.
NCCI Bundling Considerations
Transcranial Doppler (93886) and extracranial duplex (93880) are subject to NCCI edits when billed on the same date by the same provider — verify modifier eligibility and whether a modifier -59 or -XU distinction is defensible based on separately documented medical necessity for each study. CPT 70553 (MRI brain w/wo contrast) and 70551 (MRI brain without contrast) are bundled — do not bill both; select the one actually performed. For E&M services billed same-day as a diagnostic procedure (e.g., 99233 and 93880), confirm that the E&M work was separate and distinct from the pre/post-service work of the procedure and document accordingly.
🔬 ICD-10-PCS Crosswalk
ICD-10-PCS codes apply in the inpatient facility setting only and represent procedures performed during the same hospitalization where I67.82 is the principal or significant secondary diagnosis. The following PCS codes are commonly associated with the diagnostic workup or management of cerebral ischemia.
- 03CG3ZZ — Extirpation of matter from intracranial artery, percutaneous approach — May be performed when intracranial stenosis or occlusion contributing to chronic cerebral ischemia is surgically addressed via percutaneous approach; ensure the operative report confirms the specific vessel and approach. This PCS code represents carotid/intracranial endarterectomy-type intervention when documented at the specific intracranial level.
- B030YZZ — Plain Radiography of intracranial arteries using other contrast — Cerebral angiography performed to evaluate vascular anatomy in the setting of cerebral ischemia; used in the inpatient setting when conventional angiography is performed rather than CT or MR angiography.
- B031ZZZ — Fluoroscopy of intracranial arteries — Intraoperative or diagnostic fluoroscopic imaging of intracranial vessels; may be coded alongside interventional procedures in the inpatient setting when cerebral ischemia is the primary diagnostic focus.
- 00H00MZ — Insertion of neurostimulator lead into brain, open approach — In rare cases of medically refractory chronic cerebral ischemia with severe functional impairment, neurostimulation may be trialed; document the specific approach and the objective of the procedure clearly in the operative report to support this PCS code assignment.
💊 Coding Scenarios and Examples
Scenario 1 — Inpatient Admission for Cognitive Decline with Documented Chronic Cerebral Ischemia A 74-year-old female with a history of hypertension and hyperlipidemia is admitted for progressive cognitive decline over the past 8 months. MRI brain shows diffuse periventricular white matter changes consistent with chronic small vessel ischemic disease. The neurologist documents “chronic cerebral ischemia” and “early vascular dementia.” No acute infarct is identified on DWI sequences.
- Correct Coding: I67.82 (Principal Dx — Cerebral ischemia), F01.50 (Vascular dementia, unspecified, without behavioral disturbance), I10 (Essential hypertension), E78.5 (Hyperlipidemia, unspecified)
- Sequencing: I67.82 is PDx as the condition chiefly responsible for the admission after study; F01.50 is coded as a manifestation and additional diagnosis. I10 and E78.5 are secondary.
- CDI Note: Query the neurologist to explicitly link the vascular dementia to the cerebral ischemia in the clinical documentation; without that linkage, F01.50 may not be supportable as a manifestation.
Scenario 2 — Chronic Cerebral Ischemia with Concurrent Acute UTI (CC Impact) A 68-year-old male with known chronic cerebral ischemia is admitted from a skilled nursing facility with acute confusion. Workup confirms the cognitive worsening is related to a urinary tract infection; the neurologist documents the chronic cerebral ischemia as a contributing factor. Final diagnoses: acute UTI (N39.0) as PDx, chronic cerebral ischemia (I67.82) as secondary.
- Correct Coding: N39.0 (PDx — Urinary tract infection, site not specified), I67.82 (Secondary Dx — Cerebral ischemia), I10 (Hypertension)
- Sequencing: N39.0 is the principal diagnosis as the condition driving the admission after workup. I67.82 does not act as a CC or MCC in this scenario.
- CDI Note: I67.82 is not a CC or MCC — it does not independently elevate the DRG. Ensure all other secondary diagnoses (e.g., acute kidney injury if present) are captured to maximize DRG severity.
Scenario 3 — Query Situation: “Cerebral Ischemia” Language in Setting of New MRI Infarct A 71-year-old female is admitted with acute left-sided weakness. MRI brain DWI confirms a new focal infarct in the right MCA territory. The admitting physician documents “cerebral ischemia” in the admitting diagnosis and the H&P. The neurologist’s note reads “acute ischemic stroke, right MCA territory, due to cardioembolic mechanism (afib).”
- Correct Coding: I63.411 (PDx — Cerebral infarction due to embolism of right MCA), I48.91 (Unspecified atrial fibrillation), I67.82 is NOT coded — Excludes 1 applies since infarction is confirmed.
- Sequencing: I63.411 is PDx; I48.91 is secondary (etiology). I67.82 is excluded per the Excludes 1 note — never code cerebral ischemia when infarction is confirmed at the same encounter.
- CDI Note: This is the highest-risk scenario for I67.82 miscoding. If the attending’s H&P says “cerebral ischemia” but the neurologist confirms acute infarction, the neurologist’s specificity governs. Escalate to a physician query if there is conflicting terminology across providers.
⚠️ Coding Pitfalls and Tips
- Pitfall 1 — Coding I67.82 when infarction is confirmed: The Excludes 1 note is absolute — if DWI MRI or clinical documentation confirms an acute cerebral infarction, I63.x is required and I67.82 cannot be assigned at that encounter. Review radiology reports for DWI positivity before finalizing the code.
- Pitfall 2 — Using I67.82 as the default for any “brain ischemia” documentation: Not all ischemic cerebrovascular language maps to I67.82. “TIA” maps to G45.x; “acute ischemic stroke” maps to I63.x; “ischemic encephalopathy” may map to I67.4 or G93.89 depending on context. Index carefully rather than defaulting.
- Pitfall 3 — Missing the vascular dementia code: When the provider documents vascular dementia in the same note as chronic cerebral ischemia, F01.5x must be coded additionally. Leaving it off is an under-coding error and may miss CC/MCC impact from other comorbidities mapped to the dementia code.
- Pitfall 4 — Assuming I67.82 is an HCC driver for RAF purposes: I67.82 does not map to a payment HCC under CMS-HCC V28. If a risk adjustment coder or auditor is expecting HCC 249 capture from I67.82, that’s incorrect — HCC 249 requires I63.x codes. Do not substitute I67.82 for I63.x in a risk adjustment context.
- Pitfall 5 — Neglecting secondary diagnosis capture for DRG optimization: I67.82 in the DRG 070-072 family is highly sensitive to secondary diagnosis capture. Conditions like acute-on-chronic respiratory failure (J96.01), sepsis (A41.x), or severe malnutrition (E43) can elevate from DRG 072 to DRG 070, significantly impacting reimbursement. A thorough secondary diagnosis sweep is non-negotiable on every account.
- Pitfall 6 — Confusing I67.82 with I67.89 (Other cerebrovascular disease): I67.89 is the catch-all for other specified cerebrovascular diseases not described elsewhere in the I67.8 subcategory. If the provider uses specific clinical language that indexes to “cerebral ischemia” or “chronic cerebral ischemia,” I67.82 is correct. I67.89 should not be used when I67.82 fits — specificity is always preferred.