🧬 ICD-10 CM I69.122 — Dysarthria Following Nontraumatic Intracerebral Hemorrhage

Billable Code Confirmed

ICD-10 CM I69.122 is a fully billable, valid 7-character ICD-10-CM diagnosis code effective for FY2026 (October 1, 2025 - September 30, 2026) with no changes to the code since its introduction in FY2016 (the first year ICD-10-CM was implemented into the HIPAA code set).¹ The code resides in Chapter 9 (Diseases of the Circulatory System) under category I69 (Sequelae of cerebrovascular disease), specifically within subcategory I69.12 (Speech and language deficits following nontraumatic intracerebral hemorrhage), both of which are non-billable parent codes requiring extension to a fully specified child code for valid submission.¹ I69.122 is designated POA Exempt, meaning the present-on-admission indicator field on inpatient UB-04 claims must be populated with “1” (unreported/exempt), and CMS does not evaluate this code’s POA status for HAC or CC/MCC DRG payment determination purposes.² The code carries a chronic condition indicator confirming it represents a lasting condition that places limitations on self-care, communication, independent living, and social interactions.¹

Non-Billable Parent Codes

I69 (Sequelae of cerebrovascular disease) is a non-billable 3-character parent category grouping all cerebrovascular sequela codes across hemorrhagic, ischemic, and unspecified etiology subtypes — it cannot be submitted on any HIPAA-covered claim and will generate a code-invalid edit if used for billing.¹ I69.1 (Sequelae of nontraumatic intracerebral hemorrhage) is the non-billable 4-character subcategory identifying that the sequela arises from a parenchymal hemorrhagic event rather than ischemic infarction or subarachnoid bleed — insufficiently specific for billing and rejected by payers requiring the full code.¹ I69.12 (Speech and language deficits following nontraumatic intracerebral hemorrhage) is the non-billable 5-character subcategory directly above I69.122, grouping all five distinct speech and language sequela codes (I69.120 through I69.128) under the hemorrhagic etiology umbrella — coders who accidentally submit I69.12 rather than the correct child code will receive a specificity-level claim rejection.¹

Clinical Context

ICD-10 CM I69.122 is specifically assigned when the treating provider has documented dysarthria — a motor speech disorder affecting the physical production of speech sounds due to weakness, incoordination, or paralysis of the oral, laryngeal, or respiratory musculature — as a direct residual deficit resulting from a prior nontraumatic intracerebral hemorrhage, with “nontraumatic” indicating a spontaneous bleed into the brain parenchyma (e.g., from hypertension, amyloid angiopathy, or arteriovenous malformation) rather than a trauma-induced injury.² The defining coding distinction between I69.122 and its speech/language sibling I69.120 (aphasia) is the mechanistic level of impairment: dysarthria is a motor execution problem — the patient’s language formulation is intact but the neuromuscular machinery required to articulate speech is damaged — while aphasia is a linguistic processing problem where the language system itself is disrupted, regardless of motor execution capacity.³ Per ICD-10-CM and ASHA guidance, dysarthria following any form of cerebrovascular disease must be coded from the I69.x series with final characters “-22” rather than the symptom-level code R47.1 (Dysarthria and anarthria), which is expressly excluded from use once a cerebrovascular etiology has been established — the ASHA 2026 ICD-10-CM code list for SLPs explicitly notes this requirement.⁴

Code Classification

ICD-10 CM I69.122 is an ICD-10-CM diagnosis code classifying a sequela — a late effect or residual deficit — of a prior nontraumatic cerebrovascular event; it is not an acute condition, not a symptom code, and not a disease of the nervous system (Chapter 6), despite dysarthria being a neurological presentation.¹ Its placement in Chapter 9 (Diseases of the Circulatory System) rather than Chapter 6 (Diseases of the Nervous System) or Chapter 18 (Symptoms and Signs) frequently causes lookup errors by clinicians and coders who search under neurology rather than under the cerebrovascular sequela category — always navigate via the Alphabetic Index entry “Dysarthria → following → intracerebral hemorrhage” to arrive at I69.122 correctly.¹

🔍 Code Description

ICD-10 CM I69.122 describes dysarthria — impaired articulation of speech caused by damage to the motor pathways controlling the muscles of speech production — occurring as a chronic sequela of a nontraumatic intracerebral hemorrhage (ICH), meaning bleeding that occurred directly within the brain parenchyma from a spontaneous, non-injury-related cause.² Dysarthria is mechanistically distinct from aphasia and dysphasia: in dysarthria, the patient’s language is intact — they can formulate thoughts, understand spoken language, and read — but the physical production of speech is impaired due to damage to motor cortex, corticobulbar tract, basal ganglia, cerebellum, or brainstem motor nuclei controlling the lips, tongue, soft palate, larynx, and respiratory musculature.² Post-ICH dysarthria most commonly presents as spastic dysarthria (from upper motor neuron corticobulbar tract damage), hypokinetic dysarthria (from basal ganglia involvement), ataxic dysarthria (from cerebellar or cerebellar pathway involvement), or mixed dysarthria combining features of multiple types depending on the location and extent of the hemorrhage.² The specific dysarthria subtype does not change the ICD-10-CM code — I69.122 captures all clinical subtypes — but documentation of subtype is clinically important for SLP treatment planning and may be referenced in supporting medical necessity documentation for ongoing therapy claims.³

Per ICD-10-CM Official Guidelines Section I.C.9.d, category I69 may be used to indicate conditions in I60-I67 as the cause of sequelae at any time after the onset of the causal event, including during the same episode of care as the acute hemorrhage — meaning I69.122 may be reported concurrently with the acute ICH code I61.9 or other I61.x codes when both are documented in the same inpatient stay.⁵ The symptom-level code R47.1 (Dysarthria and anarthria) explicitly excludes dysarthria following cerebrovascular disease per the FY2026 Tabular Excludes 1 note, which states “dysarthria following cerebrovascular disease (I69. with final characters -22)” — this exclusion means R47.1 and I69.122 are mutually exclusive and the sequela code must replace the symptom code once the ICH etiology is established.⁴ I69.322 (dysarthria following cerebral infarction) is the ischemic-stroke counterpart to I69.122 and must not be confused with it — the hemorrhagic vs. ischemic distinction is critical for etiologic accuracy, quality reporting, and clinical documentation integrity across the continuum of care.¹

🌳 Code Tree / Hierarchy

I69 — Sequelae of cerebrovascular disease ❌ Non-billable (parent category)  
│  
├── I69.0 — Sequelae of nontraumatic subarachnoid hemorrhage ❌ Non-billable  
│ └── I69.022 — Dysarthria following nontraumatic subarachnoid hemorrhage ✅ Billable  
│  
├── I69.1 — Sequelae of nontraumatic intracerebral hemorrhage ❌ Non-billable  
│ │  
│ ├── I69.11 — Cognitive deficits following nontraumatic intracerebral hemorrhage ❌ Non-billable  
│ │ ├── I69.110 — Attention and concentration deficit following nontraumatic ICH ✅ Billable  
│ │ ├── I69.111 — Memory deficit following nontraumatic ICH ✅ Billable  
│ │ └── I69.114 — Frontal lobe and executive function deficit following nontraumatic ICH ✅ Billable  
│ │  
│ ├── I69.12 — Speech and language deficits following nontraumatic ICH ❌ Non-billable  
│ │ ├── I69.120 — Aphasia following nontraumatic ICH ✅ Billable  
│ │ ├── I69.121 — Dysphasia following nontraumatic ICH ✅ Billable  
│ │ ├── ▶▶ I69.122 — Dysarthria following nontraumatic ICH ◀◀ ✅ Billable ← THIS CODE  
│ │ ├── I69.123 — Fluency disorder following nontraumatic ICH ✅ Billable  
│ │ └── I69.128 — Other speech and language deficits following nontraumatic ICH ✅ Billable  
│ │  
│ ├── I69.13 — Monoplegia of upper limb following nontraumatic ICH ❌ Non-billable  
│ │ ├── I69.131 — Monoplegia of upper limb following nontraumatic ICH affecting right dominant side ✅ Billable  
│ │ └── I69.132 — Monoplegia of upper limb following nontraumatic ICH affecting left non-dominant side ✅ Billable  
│ │  
│ └── I69.19 — Other sequelae of nontraumatic intracerebral hemorrhage ❌ Non-billable  
│ └── I69.191 — Dysphagia following nontraumatic intracerebral hemorrhage ✅ Billable  
│  
├── I69.2 — Sequelae of other nontraumatic intracranial hemorrhage ❌ Non-billable  
│ └── I69.222 — Dysarthria following other nontraumatic intracranial hemorrhage ✅ Billable  
│  
├── I69.3 — Sequelae of cerebral infarction ❌ Non-billable  
│ └── I69.322 — Dysarthria following cerebral infarction ✅ Billable  
│  
└── I69.9 — Sequelae of unspecified cerebrovascular diseases ❌ Non-billable  
└── I69.922 — Dysarthria following unspecified cerebrovascular disease ✅ Billable

POA Exemption — Enter "1" Not a Blank

ICD-10 CM I69.122 is POA Exempt — the UB-04 POA indicator must be populated with the value “1” (unreported/not used, exempt from POA reporting); this is not the same as leaving the field blank.² CMS clarifies that “1” is equivalent to a blank on the UB-04 but was introduced because blanks are undesirable when submitting data electronically — entering “Y” or “N” for this code is incorrect and can create adjudication issues on inpatient claims.

Tip

The ASHA 2026 ICD-10-CM code resource for SLPs explicitly calls out that R47.1 (Dysarthria and anarthria) includes an Excludes 1 note for “dysarthria following cerebrovascular disease (I69. with final characters -22),” meaning once the cerebrovascular etiology is documented, SLPs and facility coders must use I69.122 — not R47.1 — on all claims for this patient going forward.⁴ Failure to make this transition from R47.1 to I69.122 when the etiology is known is a specificity error and may trigger medical necessity denial for ongoing speech therapy services if payers expect etiology-specific coding on rehabilitative claims.

✅ Includes

Dysarthria due to and following spontaneous intracerebral hemorrhage — This is the official approximate synonym for I69.122 per the ICD-10-CM index; “spontaneous” is synonymous with “nontraumatic” in this context, referring to a bleed arising from disease processes (hypertension, amyloid angiopathy, AVM, coagulopathy) rather than external trauma.¹
Post-hemorrhagic stroke motor speech disorder — When the treating provider documents a motor speech disorder following a nontraumatic ICH without specifying the exact dysarthria subtype, I69.122 is the appropriate assignment as long as the impairment is characterized as motor execution-level rather than language-formulation-level impairment.²
Spastic dysarthria following ICH — Upper motor neuron damage from an ICH affecting the corticobulbar tracts can produce spastic dysarthria, characterized by strained-strangled voice quality, slow rate, and imprecise consonants; this subtype is included within I69.122.²
Hypokinetic dysarthria following ICH — basal ganglia involvement from a hemorrhage can produce hypokinetic dysarthria with reduced loudness, monopitch, and rapid rate variability; captured under I69.122 when the ICH etiology is documented.²
Ataxic dysarthria following ICH — Cerebellar or cerebellar pathway hemorrhage can result in ataxic dysarthria with irregular articulatory breakdowns, excess and equal stress, and scanning speech; also included within I69.122.²

❌ Excludes

Excludes 1

Z86.73 — Personal history of cerebral infarction without residual deficit — This Excludes 1 note establishes mutual exclusivity: Z86.73 denotes a prior ischemic cerebral infarction that resolved completely without any lasting deficit, while I69.122 represents an active, persistent residual deficit from a hemorrhagic event — these two codes describe mutually exclusive clinical scenarios and cannot appear together on the same claim.¹ Additionally, Z86.73 applies specifically to ischemic infarction history (not hemorrhagic ICH), further reinforcing that there is no valid clinical context in which both codes would apply to the same patient for the same condition. If a patient has both a history of resolved ischemic stroke (Z86.73) and active post-ICH dysarthria (I69.122) from a separate hemorrhagic event, each condition reflects a distinct prior event and should be documented with clear etiology separation — though coding both on the same claim still conflicts with the Excludes 1 instruction and requires careful review.¹

S06.- — Sequelae of traumatic intracranial injury — Dysarthria resulting from a traumatic brain injury (TBI) must be captured from the S06.x injury category, not from I69.122, which is strictly reserved for nontraumatic hemorrhagic etiology.¹ Reporting I69.122 alongside a traumatic intracranial injury code violates the Excludes 1 instruction and constitutes an etiology misclassification — a particularly consequential error in medicolegal, workers’ compensation, and liability cases where the traumatic vs. nontraumatic distinction has direct legal and financial implications. When a patient presents with dysarthria following a documented TBI, coders must navigate to the appropriate S06.x sequela code rather than defaulting to the I69.122 cerebrovascular sequela pathway.¹

Danger

The most critical Excludes 1 error for I69.122 is coding it for post-TBI dysarthria — coders who see “intracerebral hemorrhage” in a trauma patient’s record may incorrectly assign I69.122 when the hemorrhage was traumatic in origin, which belongs in the S06.x category.¹ Always confirm from the operative report, H&P, and imaging documentation whether the intracerebral hemorrhage was spontaneous/nontraumatic (I69.122) or trauma-induced (S06.-) before assigning this code. In trauma center or emergency department settings, this distinction should be confirmed with the treating provider via physician query if documentation is ambiguous.

Excludes 2

No official Excludes 2 notes are listed in the FY2026 ICD-10-CM Tabular for I69.122.¹ Clinically, when a patient has both post-ICH dysarthria (I69.122) and post-ICH dysphagia (I69.191), aphasia (I69.120), or cognitive deficits (I69.111, I69.114) — all arising from the same hemorrhagic event — each code may and should be reported simultaneously on the same claim when each residual deficit is separately documented and addressed, as no Excludes 1 prohibits concurrent reporting of multiple I69.1x sibling codes.¹

📋 Clinical Overview

The I69.12x subcategory contains five distinct speech and language deficit codes requiring precise clinical differentiation, and the broader I69.1x block contains additional motor and functional sequela codes that frequently co-occur with dysarthria in post-ICH patients.² Accurate code selection among these closely related codes depends entirely on the treating provider’s documented characterization of the type and mechanism of the communication impairment, not on the coder’s or SLP’s inference alone.³

Feature	I69.122	I69.120	I69.121	I69.191
Condition captured	dysarthria — motor speech disorder; articulation impaired due to neuromuscular damage; language comprehension and formulation intact.	Aphasia — profound linguistic disorder; disruption of language processing itself (expressive, receptive, or global); not a motor execution problem.	Dysphasia — partial language disruption; milder than aphasia; patient retains some language function but with significant impairment in formulation or comprehension.	Dysphagia — swallowing disorder; impaired deglutition affecting oral, pharyngeal, or esophageal phase; not a speech or language deficit but frequently co-occurs post-ICH.
Mechanism	Damage to motor pathways (corticobulbar tract, basal ganglia, cerebellum, brainstem motor nuclei) impairing muscular coordination and strength for speech production.	Cortical or subcortical damage to language network (Broca’s area, Wernicke’s area, arcuate fasciculus) disrupting linguistic processing at a cognitive-linguistic level.	Same network as aphasia but less severe; partial preservation of language processing; typically associated with less extensive or more subcortical lesion involvement.	Damage to swallowing motor circuits, cranial nerve nuclei, or cortical swallowing centers impairing the coordinated muscular sequence of deglutition.
Language comprehension	Preserved — patient understands spoken and written language normally despite impaired speech production.	Impaired (receptive) or impaired expression with preserved comprehension (expressive) or both impaired (global) — language comprehension is the defining clinical target.	Partially impaired — patient may struggle to find words or understand complex language but retains functional communication capacity.	Intact — dysphagia does not affect language; patient can speak normally (unless co-occurring with speech code) but cannot swallow safely.
SLP evaluation tool	Frenchay dysarthria Assessment, Motor Speech Evaluation; intelligibility ratings; diadochokinesis testing; acoustic analysis of speech production.	WAB-R (Western Aphasia Battery — Revised), BDAE; aphasia quotient measurably reduced below norms; formal language testing required.	WAB-R or BDAE; AQ is reduced but less severely than frank aphasia; distinguishable by degree of severity and functional communication capacity.	MBSS (Modified Barium Swallow Study), FEES (Fiberoptic Endoscopic Evaluation of Swallowing); clinical swallow evaluation; no language testing required.
CDI query trigger	High — providers often document “slurred speech,” “unclear speech,” or “speech difficulty” without specifying dysarthria; query to confirm motor speech vs. language disorder.	High — “communication difficulty” or “word-finding problem” documentation requires query to establish aphasia vs. dysphasia vs. dysarthria.	Moderate — query when aphasia and dysphasia are used interchangeably in the same record; severity distinction drives code selection.	Moderate — providers may document “swallowing difficulty” or “aspiration risk” without formally documenting dysphagia; query to confirm documented diagnosis.

Important

When a post-ICH patient presents with both dysarthria (I69.122) and dysphagia (I69.191), both codes must be reported on the claim — these are distinct residual deficits affecting different functional systems and each has separate CPT therapy billing implications, separate IRF-PAI documentation requirements, and separate medical necessity criteria for continued skilled services.³ CDI review should flag any inpatient post-ICH claim coding only dysarthria without assessing whether dysphagia is also documented, as the two co-occur in a significant proportion of post-ICH patients with brainstem or bilateral cortical involvement.

Manifestations & Symptom Burden

Imprecise articulation and reduced intelligibility — The hallmark of dysarthria is reduced speech intelligibility ranging from mildly imprecise consonants to complete unintelligibility (anarthria); providers frequently document “slurred speech,” “unclear speech,” or “difficult-to-understand speech” — all of which are clinical synonyms for dysarthria that should prompt coder query to confirm the formal diagnosis and ICH etiology.²
Reduced vocal loudness and prosody impairment — Post-ICH dysarthria commonly involves reduced respiratory support for speech, resulting in a weak or breathy voice, reduced loudness, and flattened prosody (monotone, monoloudness); these features are especially prominent in basal ganglia hemorrhage causing hypokinetic dysarthria.²
Strained or strangled voice quality — Spastic dysarthria following upper motor neuron pathway damage from an ICH produces a strained, harsh voice quality with slow, labored speech and hypernasal resonance when velopharyngeal competence is compromised; this presentation is distinguishable from the flaccid quality of lower motor neuron dysarthria.²
Irregular articulatory breakdowns — Cerebellar pathway hemorrhage produces ataxic dysarthria characterized by irregular breakdowns in articulation, excess and equal stress on syllables, and a characteristic “scanning speech” pattern that can be diagnostically distinctive and should be documented precisely by the SLP for accurate code support.²
Psychosocial impact of communication impairment — Even mild dysarthria after ICH significantly reduces communicative participation, social engagement, and quality of life, and is associated with depression and social withdrawal; when depression is separately documented and diagnosed, F32.9 or a more specific depressive episode code should be co-reported alongside I69.122 rather than assuming mood sequelae are incorporated into the dysarthria code.³

Tip

Per the ASHA 2026 ICD-10-CM code list, the code R47.1 (Dysarthria and anarthria) contains a formal Excludes 1 note for “dysarthria following cerebrovascular disease (I69. with final characters -22).“⁴ This means R47.1 and I69.122 are mutually exclusive — once the ICH etiology is established in the record, all claims for that patient’s dysarthria management must use I69.122, not R47.1. SLPs and facility coders who continue submitting R47.1 after the cerebrovascular etiology is documented will generate a claim specificity error, and payers that track diagnosis code transitions may flag the claim for review.

💰 HCC Risk Adjustment

Component	Value
HCC Model	CMS-HCC v28 (2026)
HCC Category	N/A — I69.122 not independently HCC-mapped
RAF Score Contribution	0.000 (for I69.122 directly)
Chronic Condition Indicator	Chronic — meets 12-month duration and functional limitation criteria
Risk Adjustment Applicability	Indirect — signals need for annual I61.x HCC capture
Annual Recapture Required	No for I69.122; Yes for underlying I61.x
Medicare Advantage Impact	Indirect — I69.122 presence should trigger I61.x HCC gap closure audit
PACE/ESRD Model Mapping	Not mapped

ICD-10 CM I69.122 carries no direct HCC weight under CMS-HCC v28 and contributes zero to RAF score calculations for Medicare Advantage risk adjustment, as cerebrovascular sequela codes in the I69.x series are classified as manifestation/residual codes rather than active disease process codes for risk modeling purposes.⁶ However, the chronic condition designation and the clinical evidence of ongoing neurological impairment represented by I69.122 make every encounter where this code appears an HCC gap closure opportunity: the underlying nontraumatic ICH (I61.x) does carry HCC weight and must be captured annually in the medical record when it continues to impact the patient’s health status.⁶ For MA CDI programs, I69.122 without a corresponding I61.x code in the annual record represents a potential HCC gap — the provider should be queried to confirm whether the underlying hemorrhage remains clinically relevant and, if so, to document it explicitly so that it can be coded and submitted for proper RAF credit. Additionally, co-morbidities commonly associated with post-ICH patients (hypertension I10, atrial fibrillation I48.x, diabetes E11.x) frequently carry HCC weight and should be assessed for completeness on every claim containing I69.122.

🏥 MS-DRG Assignment

DRG Component	Value
MCE Principal Dx Restriction	None — I69.122 is valid as PDx when dysarthria rehabilitation is the reason for admission
CC/MCC Status	Non-CC — does not contribute to DRG severity tier elevation
DRG Severity Contribution as Secondary	None
POA Indicator	Exempt — enter “1” on UB-04
Typical DRG as PDx (Acute Inpatient)	MDC 01 — Nervous System; DRG 052-054 cluster (Nonspecific Cerebrovascular Disorders with/without CC/MCC)
Typical DRG as PDx (IRF)	IRF-PAI CMG assignment under Stroke RIC — MS-DRG logic does not apply
DRG Contribution as Secondary	None — Non-CC adds no weight

ICD-10 CM I69.122 is POA Exempt — POA indicator “1” must be entered on the UB-04 for this code, never Y/N/U/W, and never left blank on an electronic submission as that can create a claim edit depending on the submitting system’s validation logic.² As a Non-CC secondary diagnosis, I69.122 provides no DRG severity uplift on inpatient acute care claims — it does not shift a case from base DRG to CC or MCC tier, and CDI programs should not count on this code for DRG weight improvement.¹ In the IRF setting, MS-DRG logic is replaced by IRF-PAI CMG (Case Mix Group) assignment, where I69.122 listed as the primary rehabilitation diagnosis under the Stroke Rehabilitation Impairment Category (RIC 01) directly drives the CMG and therefore IRF prospective payment — accurate sequela coding and functional status scoring on the IRF-PAI are critical for appropriate CMG tier assignment and program cost management.⁵ CDI specialists reviewing post-ICH inpatient admissions with I69.122 as a secondary diagnosis should search the full record for any CC/MCC-eligible comorbidities or complications (aspiration pneumonia, hypertensive crisis, UTI, DVT, decubitus ulcer) that do carry DRG weight and may have been undercoded, as these are the true DRG severity drivers on claims where I69.122 is a secondary finding.

Dysarthria by Cerebrovascular Etiology — Sequela Series

I69.022 — dysarthria following nontraumatic subarachnoid hemorrhage — use when the hemorrhage originated in the subarachnoid space from a ruptured aneurysm or AVM; the cerebrospinal fluid spaces are the site of bleed, not the brain parenchyma.
I69.122 — dysarthria following nontraumatic intracerebral hemorrhage — this code; parenchymal hemorrhage etiology; the hemorrhagic stroke counterpart.
I69.222 — dysarthria following other nontraumatic intracranial hemorrhage — use for sequela of bleeds classified to I62.x (other intracranial hemorrhage not elsewhere classified, including subdural and extradural).
I69.322 — dysarthria following cerebral infarction — use when the dysarthria sequela arises from ischemic stroke (I63.x); this is the most frequently reported dysarthria sequela code given that ischemic stroke accounts for approximately 80% of all strokes.
I69.922 — dysarthria following unspecified cerebrovascular disease — use only when type of prior CVD cannot be determined from documentation; always attempt to specify etiology via physician query.

Co-Occurring Post-ICH Sequela Codes

I69.120 — Aphasia following nontraumatic intracerebral hemorrhage — profound language disorder, mechanistically distinct from dysarthria; may co-occur when the ICH damages both motor pathways and language networks.
I69.191 — Dysphagia following nontraumatic intracerebral hemorrhage — swallowing disorder; commonly co-occurs with dysarthria after ICH affecting brainstem or bilateral cortical motor circuits.
I69.151 — Hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage affecting right dominant side — motor paralysis co-occurring with dysarthria when the hemorrhage involves both corticospinal and corticobulbar tracts.
I69.114 — Frontal lobe and executive function deficit following nontraumatic intracerebral hemorrhage — cognitive sequela that may co-occur with dysarthria when frontal lobe involvement is present.

🛠️ Commonly Associated CPT Codes

92507 — Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual. The most frequently billed CPT code for SLP treatment of post-ICH dysarthria; billed per session with I69.122 as the supporting medical necessity diagnosis; payers expect documentation of skilled intervention, functional progress measures, and treatment goals specific to the dysarthria deficit.⁴
92521 — Evaluation of speech fluency (e.g., stuttering, cluttering). Occasionally paired with I69.122 during comprehensive speech-language evaluations when the ICH has produced both dysarthria and a fluency component; I69.122 supports medical necessity for the motor speech component of the evaluation.⁴
92522 — Evaluation of speech sound production (articulation, phonological process, apraxia, dysarthria). A highly relevant evaluation CPT code for dysarthria assessment; directly applicable to I69.122 because it explicitly includes dysarthria evaluation in its descriptor — the natural evaluation pairing for this diagnosis before initiating treatment under 92507.⁴
92523 — Evaluation of speech sound production with evaluation and report of language comprehension and expression. The comprehensive evaluation code used when both motor speech (dysarthria) and language components (to rule out co-occurring aphasia/dysphasia) need to be assessed in the same evaluation encounter; pairs with I69.122 as the primary supporting diagnosis when dysarthria is confirmed as the primary deficit.⁴
97129 — Therapeutic interventions that focus on cognitive function, initial 15 minutes; with subsequent 97130. Reported alongside 92507 and I69.122 when the post-ICH patient presents with co-occurring cognitive deficits (I69.11x) being treated concurrently with the motor speech deficit; ensure NCCI edit compatibility between 92507 and 97129 on the same date of service by verifying current quarterly edits.⁴
99223 — Initial hospital care, high complexity. Appropriate when an inpatient admission is driven by post-ICH dysarthria alongside significant comorbidities requiring high-complexity medical decision-making; I69.122 contributes to the clinical complexity narrative alongside other I69.1x and comorbidity codes on the inpatient claim.⁵

NCCI Bundling Considerations

CPT 92522 (evaluation of speech sound production including dysarthria) and 92523 (comprehensive speech-language evaluation) should not be billed together on the same date of service for the same patient by the same provider, as the 92523 descriptor subsumes speech sound production evaluation — billing both on the same date constitutes potential double billing and will generate a payer-level edit or post-payment audit flag.⁴ The treatment code 92507 is typically reported separately from evaluation codes 92522/92523 on different dates of service (evaluation day vs. treatment day), and when reported on the same date by the same provider, clinical documentation must clearly support that both a complete evaluation and a separate, distinct skilled treatment session were performed.⁴ For Medicare outpatient therapy claims with I69.122, the functional limitation reporting requirements under Medicare’s therapy billing policies require that the specific dysarthria-related functional limitation be documented at the evaluation and periodically throughout the episode of care — I69.122 must appear on every therapy claim for the duration of the medically necessary treatment episode to maintain coverage continuity.

🔬 ICD-10-PCS Crosswalk

ICD-10 CM I69.122 as a diagnosis code corresponds to the following ICD-10-PCS procedure codes that would appear on an inpatient record when the post-ICH dysarthria is being actively evaluated or treated:

F00ZDZZ — Speech Treatment, Articulation/Phonology, None — from the Physical Rehabilitation and Diagnostic Audiology section (F), Body System 00 (Rehabilitation), Root Type Z (Speech Treatment), Qualifier D (Articulation/Phonology); this is the most directly aligned PCS code for dysarthria treatment targeting articulatory precision and phonological accuracy, making it the primary ICD-10-PCS procedure code on inpatient claims where I69.122 is the driving diagnosis.¹
F00ZGZZ — Speech Treatment, Motor Speech, None — Speech Treatment with qualifier G (Motor Speech) specifically captures motor-level speech interventions such as Lee Silverman Voice Treatment (LSVT), SPEAK OUT!, oral motor exercises, and respiratory-phonatory coordination therapy directly targeting the neuromotor basis of dysarthria; directly aligns with I69.122 as a diagnosis.¹
F00ZFZZ — Speech Treatment, Voice, None — Used when the post-ICH dysarthria involves significant voice production impairment (e.g., breathiness, strained-strangled quality, reduced loudness) and voice-specific therapeutic techniques are employed in the inpatient rehabilitation program alongside articulation treatment.¹
F07Z0ZZ — Assessment, Speech-Language and Communication, Filtered Speech — From the Physical Rehabilitation Diagnostic Audiology section; may be coded when a comprehensive motor speech assessment using standardized dysarthria evaluation instruments is performed during the inpatient stay to establish baseline severity and guide rehabilitation goals for the episode of care.¹

💊 Coding Scenarios and Examples

Scenario 1 — Acute Inpatient Admission with Concurrent ICH and Dysarthria Documentation

A 73-year-old male with chronic hypertension is brought to the ED via EMS after his wife noticed sudden onset of slurred, unintelligible speech and right arm weakness. CT head reveals a left putaminal intracerebral hemorrhage of 3.1 cm without midline shift. The admitting neurologist documents in the H&P: “Patient presents with acute nontraumatic intracerebral hemorrhage, left putamen, secondary to chronic uncontrolled hypertension. Exam notable for severe dysarthria — speech nearly unintelligible — and right arm weakness.” SLP is consulted on day 2 and documents severe spastic dysarthria with intelligibility less than 20% in structured testing. The attending neurologist’s daily note references the SLP findings and confirms severe post-hemorrhagic dysarthria. The patient is managed medically with blood pressure control; no surgical intervention is performed.

Correct Coding:

PDx: I61.0 — Nontraumatic intracerebral hemorrhage in hemisphere, subcortical — the ICH is the acute condition responsible for the admission and is sequenced as PDx per UHDDS guidelines.
SDx: I69.122 — Dysarthria following nontraumatic intracerebral hemorrhage — per ICD-10-CM Section I.C.9.d, the sequela code may be reported in the same episode of care as the acute hemorrhage when both are documented; the neurologist adopted the SLP findings and confirmed the dysarthria as a direct result of the hemorrhage.
SDx: I69.151 — Hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage affecting right dominant side — the right arm weakness is documented and should be captured as an additional sequela code.
SDx: I10 — Essential (primary) hypertension — documented etiology of the hemorrhage; coded as an additional diagnosis representing a comorbidity treated and managed during the admission.

Sequencing: I61.0 is PDx as the acute condition driving the admission. I69.122 and I69.151 are additional sequela codes per ICD-10-CM guidelines permitting concurrent acute and sequela coding. POA for I69.122 must be entered as “1” (exempt). I10 is an additional comorbidity. CDI Note: Confirm the attending neurologist has explicitly documented the dysarthria as resulting from the ICH in their own clinical note — SLP documentation of “severe spastic dysarthria” supports but does not independently establish the etiology for coding purposes. The physician adoption of the SLP findings in the daily note is what authorizes the code assignment.

Scenario 2 — IRF Admission for Post-ICH Rehabilitation

A 65-year-old female is transferred from acute care to an inpatient rehabilitation facility 10 days after a right cerebellar and brainstem nontraumatic intracerebral hemorrhage. She presents with moderate ataxic dysarthria (intelligibility approximately 65% in structured context), dysphagia requiring modified texture diet, and ataxic gait requiring maximum assistance. The physiatrist’s admission note documents: “Patient admitted for intensive rehabilitation following nontraumatic intracerebral hemorrhage. Primary rehabilitation impairment: ataxic dysarthria. Secondary impairments: dysphagia and ataxic gait. All residual deficits are sequelae of the cerebellar/brainstem hemorrhage.” The IRF-PAI documents Stroke RIC with I69.122 as the primary impairment code.

Correct Coding (IRF Facility):

PDx: I69.122 — Dysarthria following nontraumatic intracerebral hemorrhage — the primary rehabilitation impairment driving the IRF admission; correctly listed as PDx and drives IRF-PAI CMG assignment under Stroke RIC.
SDx: I69.191 — Dysphagia following nontraumatic intracerebral hemorrhage — documented secondary rehabilitation impairment; must be captured to reflect the full functional burden and support SNF/IRF level-of-care justification.
SDx: I61.9** — Nontraumatic intracerebral hemorrhage, unspecified — the underlying hemorrhage should be coded as an additional diagnosis for etiologic context and MA HCC annual capture purposes; location-specific I61.x code should be used if the specific hemorrhage location is documentable.
SDx: I10 — Essential (primary) hypertension — managed comorbidity.

Sequencing: I69.122 is appropriately the PDx for the IRF admission as it represents the primary rehabilitation reason for admission. Multiple I69.1x codes are appropriate and necessary when all residual deficits are documented. CDI Note: IRF claims require that the 3-hour therapy rule be documented (at least 15 hours of therapy in a 7-consecutive-day period with at least 3 hours on each of at least 5 days), and each therapy discipline must document its specific treatment targets — SLP documentation must reflect skilled dysarthria and dysphagia interventions tied directly to I69.122 and I69.191 for continued coverage validation.

Scenario 3 — Outpatient SLP Therapy Claim Post-Discharge

A 58-year-old male presents for outpatient SLP therapy six weeks after discharge following a right thalamic nontraumatic intracerebral hemorrhage. He demonstrates moderate mixed spastic-ataxic dysarthria with approximately 70% intelligibility in structured settings and reduced intelligibility in noisy environments. The SLP documents measurable functional progress and establishes treatment goals targeting conversational intelligibility at 90% in structured settings. The treating SLP bills for individual speech treatment.

Correct Coding:

CPT: 92507 — Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual — direct SLP treatment of post-ICH dysarthria; billed per session.
PDx: I69.122 — Dysarthria following nontraumatic intracerebral hemorrhage — first-listed diagnosis on all outpatient SLP therapy claims; must appear on every claim throughout the episode of care to maintain medical necessity documentation continuity.
SDx: I61.9 — Nontraumatic intracerebral hemorrhage, unspecified — reported as additional diagnosis to provide etiologic context and support MA annual HCC capture.

Sequencing: I69.122 is first-listed as the diagnosis driving the outpatient therapy encounter. Per outpatient coding guidelines (Section IV), only confirmed diagnoses are reported — do not add speculative or uncertain diagnoses from the evaluation findings unless confirmed by the treating provider. CDI Note: Do not report R47.1 (Dysarthria and anarthria) on these claims — the ICD-10-CM Tabular Excludes 1 instruction at R47.1 explicitly excludes “dysarthria following cerebrovascular disease (I69. with final characters -22),” meaning once the ICH etiology is established, R47.1 is incorrect and I69.122 is the required code for all subsequent claims. Submitting R47.1 when I69.122 is appropriate is a specificity error that can trigger medical necessity denials from payers that require etiology-specific coding on therapy claims.

⚠️ Coding Pitfalls and Tips

Pitfall 1 — Using R47.1 instead of I69.122 after the ICH etiology is established: The single most frequent specificity error in dysarthria coding is continued use of R47.1 (Dysarthria and anarthria) after the provider has documented a cerebrovascular etiology.⁴ The ICD-10-CM Tabular explicitly excludes “dysarthria following cerebrovascular disease (I69. with final characters -22)” from R47.1 via an Excludes 1 note — these codes are mutually exclusive once etiology is known. Coders and SLP billers must transition from R47.1 to I69.122 at the point the ICH etiology is documented, not continue to use the symptom code on subsequent claims.
Pitfall 2 — Confusing dysarthria (I69.122) with aphasia (I69.120) or dysphasia (I69.121): These three sibling codes are frequently conflated because all involve speech or communication impairment post-ICH, but they represent mechanistically distinct conditions.² Dysarthria is a motor execution disorder with intact language; aphasia is a language processing disorder; dysphasia is a partial language disorder. When documentation uses vague terms like “communication difficulty,” “speech problems,” or “difficulty speaking,” a physician query is required before assigning any of these codes — do not infer the specific type from clinical inference or SLP notes alone without the physician’s confirmation.
Pitfall 3 — Entering Y or N in the POA field instead of “1” for exempt codes: I69.122 is POA Exempt and must be submitted with POA indicator “1” (unreported/exempt) on UB-04 inpatient claims.² Entering “Y” is not equivalent to “1” even though both technically result in the claim being processed — the “1” indicator communicates to the payer that the code is on the CMS POA exempt list, while “Y” communicates the code was present on admission, which is a factually different and potentially confusing claim message. Train billing and coding staff on the specific POA exemption indicator to avoid this systemic error.
Pitfall 4 — Assigning I69.122 for post-TBI dysarthria: I69.122 is exclusively for nontraumatic ICH; dysarthria from traumatic brain injury must be coded from the S06.x series per the Excludes 1 instruction.¹ In emergency and trauma settings, coders must carefully confirm from the H&P and imaging whether the intracranial hemorrhage was spontaneous (nontraumatic — I69.122) or trauma-induced (traumatic — S06.-) before assigning the sequela code. This distinction carries legal, coverage, and quality implications that extend well beyond simple coding accuracy.
Pitfall 5 — Using I69.322 (ischemic stroke dysarthria) when the ICH was hemorrhagic: Because ischemic strokes are far more common than hemorrhagic strokes, coders may default to I69.322 (dysarthria following cerebral infarction) for any post-stroke dysarthria without verifying whether the underlying event was hemorrhagic or ischemic.¹ This etiology-level coding error is auditable and will result in a mismatch between the diagnosis code and the clinical record imaging documentation. Always verify the type of prior cerebrovascular event from the acute care discharge summary or imaging report before selecting among the I69.x22 dysarthria sequela codes.
Pitfall 6 — Failing to report all concurrent I69.1x sequela codes: When a post-ICH patient has multiple residual deficits — dysarthria (I69.122), dysphagia (I69.191), hemiplegia (I69.151), and cognitive deficits (I69.114) — all of which are documented and addressed during the admission, each code should be reported.⁵ Reporting only I69.122 while omitting co-documented residual deficits represents coding incompleteness that may undermine IRF admission criteria documentation, SNF PDPM category accuracy, and longitudinal clinical record integrity. Review all therapy discipline assessments (SLP, PT, OT) and the attending’s documentation to ensure every documented residual deficit from the hemorrhagic event is captured with the appropriate I69.1x code.

📚 Sources

¹ Centers for Medicare & Medicaid Services and the National Center for Health Statistics. *ICD-10-CM Official Tabular List of Diseases and Injuries, FY2026 (October 1, 2025 - September 30, 2026).* Code I69.122 — **dysarthria** following nontraumatic intracerebral hemorrhage; Excludes 1 notes, POA exemption, chronic condition indicator, code history. CMS, 2025. https://icdlist.com/icd-10/I69.122 ² Unbound Medicine. "I69.122 — Dysarthria Following Nontraumatic Intracerebral Hemorrhage." *ICD-10-CM*, 10th ed. Centers for Medicare and Medicaid Services and the National Center for Health Statistics, 2026. https://www.unboundmedicine.com/icd/view/ICD-10-CM/914097/all/I69_122___Dysarthria_following_nontraumatic_intracerebral_hemorrhage ³ Carolina Therapy Services. "Commonly Used Speech Therapy ICD-10 Treatment Diagnosis Codes." Including I69.122 — Dysarthria following nontraumatic intracerebral hemorrhage. https://www.carolinatherapy.net/wp-content/uploads/Commonly-Used-ST-ICD10-Tx.pdf ⁴ American Speech-Language-Hearing Association (ASHA). *2026 ICD-10-CM Diagnosis Codes Related to Speech, Language, and Swallowing Disorders.* First Edition, effective October 1, 2025. Including R47.1 Excludes 1 note for I69. final characters -22. ASHA, 2025. https://www.asha.org/siteassets/uploadedfiles/icd-10-codes-slp.pdf ⁵ Centers for Medicare & Medicaid Services. *ICD-10-CM Official Guidelines for Coding and Reporting, FY2026 — Section I.C.9.d: Sequelae of Cerebrovascular Disease; Section II: Selection of Principal Diagnosis; Section IV: Diagnostic Coding and Reporting Guidelines for Outpatient Services.* CMS, 2025. ⁶ Centers for Medicare & Medicaid Services. *2026 Announcement of Calendar Year (CY) 2026 Medicare Advantage Capitation Rates and Part C and Part D Payment Policies — CMS-HCC Risk Adjustment Model v28.* CMS, April 2025.

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Recent Notes

I69.122