🧬 ICD-10 CM I69.192 — Facial Weakness Following Nontraumatic Intracerebral Hemorrhage
Billable Code Confirmed
ICD-10 CM I69.192 is a fully billable, 7-character ICD-10-CM code valid for FY2026, meeting the highest level of specificity within the I69.19 subcategory. The code structure identifies: I69 (sequelae of cerebrovascular disease) → .1 (nontraumatic intracerebral hemorrhage) → .19 (other sequelae) → .192 (facial weakness specifically). No additional characters are required, and this code is POA-reportable as a sequela.
Non-Billable Parent Codes
I69 (Sequelae of cerebrovascular disease) is a non-billable category-level code requiring additional characters to specify the type of cerebrovascular event and the nature of the sequela. I69.1 (Sequelae of nontraumatic intracerebral hemorrhage) is non-billable; it lacks the specificity to identify the type of deficit, making it unacceptable as a standalone reported code. I69.19 (Other sequelae of nontraumatic intracerebral hemorrhage) is also non-billable as a subcategory header — all three require further extension to the 6th or 7th character for valid billing.
Clinical Context
ICD-10 CM I69.192 captures the specific residual neurological deficit of facial weakness — including facial droop, facial paresis, or central facial palsy — that persists or develops following a nontraumatic intracerebral hemorrhage (ICH). This code is clinically distinct from facial weakness following cerebral infarction (I69.392) or following traumatic brain injury (S06.-), and documentation must explicitly link the deficit to the prior hemorrhagic event.
Code Classification
ICD-10 CM I69.192 is an ICD-10-CM diagnosis code — it is NOT a procedure code and carries no CPT or ICD-10-PCS equivalent. It classifies a sequela (late effect) of disease, meaning the acute hemorrhagic phase has resolved and this code represents the residual neurological deficit. It is never appropriate to code this simultaneously with an active acute intracerebral hemorrhage code (I61.-) for the same event.
🔍 Code Description
ICD-10 CM I69.192 identifies facial weakness as a sequela of a prior nontraumatic intracerebral hemorrhage (ICH). A sequela, by ICD-10-CM definition, is a residual condition that remains after the acute phase of an illness has resolved, and per Coding Guideline I.C.9.d, there is no time limit on when a sequela may be coded — it can be documented from onset or arise years after the event. The facial weakness captured here reflects damage to the corticobulbar tract or facial nerve motor pathways caused by the hemorrhagic lesion, resulting in central-facial-palsy that is clinically distinguishable from peripheral facial palsy (such as Bell’s palsy, coded to G51.0). Unlike peripheral palsy, central facial palsy typically spares the forehead due to bilateral cortical representation of the frontalis muscle, and this distinction is critical for clinical documentation and code selection accuracy.
Facial weakness following ICH has significant functional implications, including difficulty with speech articulation (R47.81 dysarthria), oral feeding, and facial expression, all of which may drive medical necessity for rehabilitation services. Coders working inpatient profee should note that I69.192 can coexist with other sequela codes from the I69.1x subcategory when multiple residual deficits are present — for example, a patient may simultaneously carry I69.191 (dysphagia following nontraumatic ICH) and I69.192 when both deficits are documented and linked to the same prior hemorrhage. ICD-10-CM guideline I.C.9.d explicitly permits multiple sequela codes from category I69 to be reported together when clinically supported.
🌳 Code Tree / Hierarchy
I69 Sequelae of cerebrovascular disease ❌ Non-billable
│
├── I69.0 Sequelae of nontraumatic subarachnoid hemorrhage ❌ Non-billable
├── I69.1 Sequelae of nontraumatic intracerebral hemorrhage ❌ Non-billable
│ │
│ ├── I69.10 Unspecified sequelae of nontraumatic intracerebral hemorrhage ✅ Billable
│ ├── I69.11x Cognitive deficits following nontraumatic intracerebral hemorrhage ✅ Billable (various 7th chars)
│ ├── I69.12x Speech and language deficits following nontraumatic intracerebral hemorrhage ✅ Billable (various 7th chars)
│ ├── I69.13x Monoplegia of upper limb following nontraumatic intracerebral hemorrhage ✅ Billable (various 7th chars)
│ ├── I69.14x Monoplegia of lower limb following nontraumatic intracerebral hemorrhage ✅ Billable (various 7th chars)
│ ├── I69.15x Hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage ✅ Billable (various 7th chars)
│ ├── I69.16x Other paralytic syndrome following nontraumatic intracerebral hemorrhage ✅ Billable (various 7th chars)
│ │
│ ├── I69.19 Other sequelae of nontraumatic intracerebral hemorrhage ❌ Non-billable
│ │ │
│ │ ├── I69.190 Apraxia following nontraumatic intracerebral hemorrhage ✅ Billable
│ │ ├── I69.191 Dysphagia following nontraumatic intracerebral hemorrhage ✅ Billable
│ │ ├── I69.192 Facial weakness following nontraumatic intracerebral hemorrhage ◀ THIS CODE ✅ Billable
│ │ ├── I69.193 Ataxia following nontraumatic intracerebral hemorrhage ✅ Billable
│ │ └── I69.198 Other sequelae of nontraumatic intracerebral hemorrhage ✅ Billable
│ │
└── I69.2 Sequelae of other nontraumatic intracranial hemorrhage ❌ Non-billableWhy I69.192 Over I69.198?
ICD-10 CM I69.198 is the “other sequelae” catch-all for nontraumatic ICH and should only be used when no specific sequela code exists. Facial weakness has its own dedicated code at I69.192, making I69.198 incorrect and potentially audit-triggering for this deficit — specificity always wins, and payers expect the most precise code supported by documentation.
Tip
When a patient presents with facial weakness post-ICH, query the physician to confirm: (1) the causal link to the prior hemorrhagic event, (2) whether other deficits are also present (dysphagia, ataxia, apraxia) that warrant additional I69.19x codes, and (3) laterality of the weakness for documentation completeness even though I69.192 does not have laterality characters — it supports rehab coding precision.
✅ Includes
- Facial droop following nontraumatic intracerebral hemorrhage — clinically refers to the downward displacement or asymmetry of facial musculature on the affected side due to upper motor neuron disruption from the hemorrhagic lesion.
- Central facial palsy following nontraumatic ICH — involves weakness of the lower two-thirds of the face contralateral to the hemorrhagic lesion, sparing the forehead; this is the classic post-stroke facial weakness pattern.
- Post-hemorrhagic facial paresis — partial loss of voluntary facial movement persisting as a residual deficit after the acute ICH event has resolved.
❌ Excludes
Excludes 1
Z86.73 — Personal history of cerebral infarction without residual deficit (and history of PRIND/RIND): This is an Excludes 1 note at the I69 category level. Z86.73 is used when there are NO residual neurological deficits from a prior cerebrovascular event — it is mutually exclusive with I69.192 because the presence of facial weakness means a residual deficit exists; you cannot bill both simultaneously for the same event. Coding both Z86.73 and I69.192 together would be a contradictory and non-compliant code pairing that would flag on audit. S06.- — Sequelae of traumatic intracranial injury: This Excludes 1 note prohibits the use of I69.192 when the facial weakness stems from a traumatic brain injury; traumatic etiology requires codes from the S06 category with the appropriate sequela 7th character (S), and these two categories are never coded together for the same event.
Danger
The most common Excludes 1 error with I69.192 is assigning Z86.73 alongside it — this happens when a coder notes the history of ICH in the documentation and adds Z86.73 as a “history” code without recognizing that the ongoing facial weakness means an active sequela exists, which makes Z86.73 incorrect and mutually exclusive per the Excludes 1 note at I69.
Excludes 2
ICD-10 CM I69.392 — Facial weakness following cerebral infarction: This is an Excludes 2 scenario, meaning if a patient has a history of BOTH a prior nontraumatic ICH AND a prior cerebral infarction, each causing its own distinct facial weakness deficit, both I69.192 and I69.392 could theoretically be coded simultaneously if documentation supports two separate causative events. In practice, this requires unambiguous physician documentation linking each facial weakness deficit to its respective cerebrovascular event — a strong CDI query opportunity.
📋 Clinical Overview
Central vs. Peripheral Facial Weakness: Code Selection Drivers
Facial weakness following ICH represents upper motor neuron (UMN) disruption of corticobulbar pathways, which is clinically and anatomically distinct from lower motor neuron (LMN) peripheral facial palsy. Accurate documentation of the mechanism and location of the deficit is essential for selecting I69.192 over codes like G51.0 (Bell’s palsy) or G51.9 (disorder of facial nerve, unspecified). The hemorrhagic lesion in the motor cortex, internal capsule, or brainstem can produce contralateral facial weakness that manifests predominantly in the lower face. CDI teams should prompt providers to document “facial weakness as sequela of prior nontraumatic intracerebral hemorrhage” explicitly rather than simply “facial droop” to support compliant sequela code selection.
| Feature | I69.192 | I69.392 | G51.0 |
|---|---|---|---|
| Etiology | Sequela of nontraumatic intracerebral hemorrhage | Sequela of cerebral infarction (ischemic stroke) | Idiopathic peripheral facial nerve palsy (Bell’s palsy) |
| Motor Neuron Type | Upper motor neuron (UMN) lesion | Upper motor neuron (UMN) lesion | Lower motor neuron (LMN) lesion |
| Forehead Sparing | Yes — forehead typically spared due to bilateral cortical input | Yes — forehead typically spared | No — entire ipsilateral face affected including forehead |
| Timing | Residual/sequela; acute phase resolved | Residual/sequela; acute phase resolved | Acute onset; coded during active episode |
| HCC Impact | No independent HCC value in V28 | No independent HCC value in V28 | No HCC value |
| DRG Driver | MDC 01; DRG 056/057 as PDX | MDC 01; DRG 056/057 as PDX | MDC 01 depending on PDX context |
Important
CDI trigger: When a provider documents “facial droop” or “facial asymmetry” in a patient with known prior ICH history, query to confirm whether this is an ongoing sequela of the ICH or a new acute finding — the answer drives the entire code selection and DRG pathway. Sequela documentation must explicitly link the deficit to the prior hemorrhage.
Manifestations & Symptom Burden
- Dysarthria (R47.81): Facial muscle weakness contributes to slurred or imprecise speech; may be separately coded when documented and clinically distinct from the facial weakness itself, supporting SLP referral and CPT 92507 billing.
- Dysphagia (I69.191): Can coexist with I69.192 as a separate sequela code when oropharyngeal muscle weakness from the same ICH event impairs swallowing; both codes may be reported simultaneously per ICD-10-CM guidelines.
- Oral feeding difficulty (R63.3): Secondary functional impact of facial weakness affecting lip seal and oral bolus control; documented by SLP and supports skilled rehab medical necessity.
- Facial pain/altered sensation: May accompany motor weakness; documented separately using appropriate symptom codes if not integral to the facial weakness itself.
- Psychosocial impact: Facial disfigurement and asymmetry contribute to depression and anxiety post-stroke, which should be captured with appropriate Z and F codes when documented.
Tip
Manifestation coding pearl: I69.192 is NOT a manifestation code — it is a sequela code functioning as a standalone diagnosis. You do not need to use the etiology/manifestation convention (code first/use additional code) for this code. The “use additional code” instructions at I69.19 direct coders to add dysphagia codes (R13.1x) with **I69.19**1 specifically; I69.192 does not carry a “use additional code” note for facial weakness severity.
💰 HCC Risk Adjustment
| Model | HCC Assignment | RAF Impact | Notes |
|---|---|---|---|
| CMS HCC V28 (MA) | None — not HCC-mapped | No independent RAF score | Facial weakness alone does not trigger HCC |
| CMS HCC V24 (legacy) | None — not HCC-mapped | No independent RAF score | Hemiplegia sequelae (I69.15x) carry HCC 103 |
| CDPS | Not applicable to inpatient DRG | N/A | N/A |
ICD-10 CM I69.192 carries no independent RAF value under CMS HCC Model V28, which means it will not boost a patient’s risk score or drive MA plan reimbursement on its own. However, its accurate capture is still clinically meaningful — it documents the full burden of the patient’s post-hemorrhagic neurological status and can support medical necessity for ongoing rehabilitative services. If the patient also has hemiplegia or hemiparesis from the same ICH event, those codes (I69.151-I69.154) DO carry HCC 103 under V28 and should be captured in addition to I69.192 when clinically supported. For profee and MA risk adjustment audits, coders should ensure that any documented neurological deficit with HCC value is not being missed while focusing solely on non-HCC sequela codes like I69.192.
🏥 MS-DRG Assignment
| Sequencing Role | MCC Present | CC Present | Assigned DRG | MDC |
|---|---|---|---|---|
| Principal Diagnosis | Yes | N/A | DRG 056 — Degenerative Nervous System Disorders with MCC | MDC 01 |
| Principal Diagnosis | No | N/A | DRG 057 — Degenerative Nervous System Disorders without MCC | MDC 01 |
| Secondary Diagnosis | Varies | Varies | Driven by PDX; I69.192 may function as CC/MCC depending on grouper version | MDC 01 |
When I69.192 is the principal diagnosis (e.g., patient admitted for inpatient rehab evaluation of post-ICH facial weakness and associated neurological deficits), it groups to MDC 01 under DRG 056 with MCC or DRG 057 without MCC. The DRG 056/057 pair covers degenerative nervous system disorders, and sequelae of ICH presenting as the primary reason for admission fall within this grouping logic. CC/MCC status of secondary diagnoses will then be the key DRG weight driver — always verify the current FY2026 v43.0 grouper for CC/MCC designations, as these change annually. For profee inpatient coding, the sequencing rule is firm: the principal diagnosis is the condition established after study to be chiefly responsible for occasioning the admission, so if facial weakness post-ICH is driving the admission, it earns PDX status over other comorbidities.
🔗 Related ICD-10-CM Codes
Other Sequelae of Nontraumatic ICH (I69.19x Family)
- I69.190 — Apraxia following nontraumatic intracerebral hemorrhage
- I69.191 — Dysphagia following nontraumatic intracerebral hemorrhage
- I69.193 — Ataxia following nontraumatic intracerebral hemorrhage
- I69.198 — Other sequelae of nontraumatic intracerebral hemorrhage (catch-all; use only when no specific code exists)
Facial Weakness Sequelae — Cross-Etiology Comparison Codes
- I69.092 — Facial weakness following nontraumatic subarachnoid hemorrhage
- I69.292 — Facial weakness following other nontraumatic intracranial hemorrhage
- I69.392 — Facial weakness following cerebral infarction
- I69.892 — Facial weakness following other cerebrovascular disease
- I69.992 — Facial weakness following unspecified cerebrovascular disease
- G51.0 — Bell’s palsy (peripheral; not a sequela code — used for active idiopathic facial palsy)
- Z86.73 — Personal history of cerebral infarction without residual deficit (use when NO sequelae present)
🛠️ Commonly Associated CPT Codes
NCCI Bundling Considerations
When billing rehabilitation CPT codes for facial weakness post-ICH, ensure that speech therapy codes (92507) and physical/occupational therapy codes (97110, 97530) are not billed together by the same provider on the same day without appropriate modifiers (-XP for separate practitioners). NCCI edits bundle many therapeutic procedure codes when performed by the same discipline in the same session — always review the current NCCI table before billing multiple rehab codes on the same date. Inpatient profee coders should note that therapy CPT codes are typically billed by outpatient or SNF providers; inpatient facility coders capture these services under the DRG, while the profee side bills E/M or care management codes.
92507 — Treatment of speech, language, voice, communication, and/or auditory processing (individual): Billed by SLPs for facial weakness contributing to dysarthria or communication deficits; requires a physician order and documented skilled care necessity. Medical necessity is strongly supported by I69.192 as the diagnosis, particularly when paired with R47.81 (dysarthria). Medicare LCDs (e.g., A52866) specifically list I69.192 as a covered diagnosis for SLP services.
97110 — Therapeutic exercises (15-minute timed units): Billed by PT or OT for neuromuscular strengthening exercises targeting facial musculature or associated upper extremity deficits; must be medically necessary and documented with measurable functional goals. When billed by a different discipline than SLP on the same day, modifier XP may be required to bypass NCCI edits.
97112 — Neuromuscular reeducation: Particularly relevant for post-ICH facial weakness as it specifically targets reeducation of movement, balance, and kinesthetic sense in neurologically impaired patients; supports motor relearning approaches for central facial palsy rehabilitation.
97530 — Therapeutic activities: Covers dynamic activities that require the use of cognitive and perceptual skills as well as coordinated body movements; applicable when facial weakness is addressed within the context of ADL retraining (e.g., eating, oral hygiene). Billed in 15-minute timed units with -GP modifier for -PT services under Medicare.
99233 — Subsequent hospital care (high complexity): The attending physician’s daily profee E/M code during an inpatient stay where post-ICH neurological deficits including facial weakness are being managed; medical decision-making complexity is supported by the neurological condition and ongoing rehabilitation coordination.
🔬 ICD-10-PCS Crosswalk
There is no direct ICD-10-PCS procedure code that maps specifically to “facial weakness” as a diagnosis — PCS codes capture the procedures performed to treat the condition rather than the diagnosis itself. The following PCS codes represent procedures that may be performed during an inpatient stay where I69.192 is a relevant diagnosis:
F07Z6ZZ — Motor Treatment of Facial Muscles using Therapeutic Exercise (Physical Rehabilitation and Diagnostic Audiology section): Captures inpatient physical rehabilitation targeting facial motor function; applicable when the rehab team performs structured therapeutic exercise directed at the facial musculature as part of the post-ICH recovery plan.
F09Z0ZZ — Assessment of Facial Muscles Motor Function (Physical Rehabilitation and Diagnostic Audiology section): Used when a formal motor assessment of facial muscle function is performed as part of the inpatient rehabilitation evaluation, establishing baseline deficit severity prior to developing a treatment plan.
F06ZUZZ — Speech Treatment using Augmentative/Alternative Communication (Rehabilitation section): Applicable when facial weakness is severe enough to impair verbal communication and augmentative communication strategies are initiated during the inpatient stay as part of SLP intervention.
💊 Coding Scenarios and Examples
Scenario 1 — Inpatient Rehab Admission for Post-ICH Deficits Mr. D, a 67-year-old male, was admitted to an acute inpatient rehabilitation unit following discharge from the acute care hospital after a left basal ganglia nontraumatic intracerebral hemorrhage three weeks prior. He presents with right-sided facial droop, right-sided arm weakness, and dysphagia, all documented by the attending physiatrist as residual deficits from the prior hemorrhagic event. He requires skilled PT, OT, and SLP services.
- Correct Coding: I69.192 (facial weakness), I69.151 (hemiplegia affecting right dominant side following nontraumatic ICH), I69.191 (dysphagia following nontraumatic ICH)
- Sequencing: I69.151 as PDX (drives DRG and HCC 103); I69.192 and I69.191 as additional diagnoses
- CDI Note: Physiatrist must explicitly document each deficit as a sequela of the prior ICH — “residual right-sided facial weakness due to left basal ganglia ICH” — not merely “facial droop history.”
Scenario 2 — Outpatient Neurology Visit (Profee) Ms. T, a 58-year-old female, presents to neurology clinic 6 months after a right thalamic nontraumatic intracerebral hemorrhage. She reports persistent left-sided facial weakness affecting her smile and speech clarity. No hemiplegia present. Neurologist documents “left facial weakness, sequela of right thalamic ICH.”
- Correct Coding: I69.192 (facial weakness following nontraumatic ICH), R47.81 (dysarthria, if separately documented)
- Sequencing: I69.192 as first-listed diagnosis; R47.81 as additional if documented
- CDI Note: Verify neurologist explicitly linked the facial weakness to the thalamic ICH — vague documentation such as “facial weakness, history of ICH” may not be specific enough without the causal linkage phrase.
Scenario 3 — Inpatient Acute Care with Multiple Sequelae Mrs. K is admitted acutely for pneumonia (J18.9). PMH significant for nontraumatic ICH 2 years ago with residual facial weakness (I69.192) and ataxia (I69.193), documented as active comorbidities affecting her care (aspiration risk from facial weakness complicating swallowing during illness). Physician documents facial weakness and ataxia as ongoing sequelae of prior ICH complicating the current admission.
- Correct Coding: J18.9 (PDX — pneumonia), I69.192 (facial weakness — secondary, CC/MCC status per grouper), I69.193 (ataxia — secondary)
- Sequencing: J18.9 as PDX since pneumonia prompted the admission; sequela codes support secondary diagnoses affecting care
- CDI Note: The aspiration risk link between facial weakness and pneumonia is a powerful CDI opportunity — query for aspiration pneumonia (J69.0) if supported, which would change the PDX and may impact DRG.
⚠️ Coding Pitfalls and Tips
- Never code I69.192 with an active ICH code simultaneously for the same hemorrhagic event. Codes from I61.- (nontraumatic ICH) represent the acute phase; once the hemorrhage is resolved and residual deficits persist, you transition to I69.192. These two codes cannot coexist for the same event — doing so represents a sequencing and classification error that will trigger a claim edit.
- Do not default to I69.198 when I69.192 is available. I69.198 is the “other specified” catch-all code and is inappropriate when facial weakness is the documented deficit — I69.192 exists precisely for this. Using I69.198 for facial weakness is a specificity failure and can result in a down-coded claim or audit finding.
- Z86.73 is incompatible with I69.192 — if the patient has a sequela, they cannot simultaneously have “history without residual deficit.” This is an Excludes 1 note at the I69 category level. A surprisingly common error in concurrent condition coding, especially when a history and physical lists both Z86.73 and active sequela codes.
- The causal link is non-negotiable. ICD-10-CM Guideline I.C.9.d requires that sequela codes from I69 only be assigned when the deficit is documented as causally related to the prior cerebrovascular event. “Facial weakness” alone without “following nontraumatic ICH” or equivalent language does not support I69.192 — query the physician if the link is implied but not explicit.
- Multiple I69.19x codes may be coded simultaneously. If the patient has facial weakness AND dysphagia AND ataxia all stemming from the same ICH, you code I69.192 + I69.191 + I69.193 — this is not duplicate coding; it is accurate representation of the full neurological deficit burden and supports both DRG complexity and medical necessity documentation for rehabilitation services.
- Laterality documentation matters even without a laterality character. I69.192 does not have laterality sub-characters (unlike hemiplegia codes), but the physician should still document which side of the face is affected. This supports CPT-level rehab documentation, functional goal setting, and potential future code updates as ICD-10-CM specificity evolves.