🧬 ICD-10 CM I69.193 — Ataxia Following Nontraumatic Intracerebral Hemorrhage
Billable Code Confirmed
ICD-10 CM I69.193 is a fully specified, 6-character ICD-10-CM code valid and billable for FY2026. The sixth character “3” designates ataxia as the specific neurological sequela within the I69.19 subcategory, distinguishing it from apraxia, dysphagia, facial weakness, and other deficit types in the same family. No additional characters or further specificity are required for claim submission.
Non-Billable Parent Codes
I69 (Sequelae of cerebrovascular disease) is a non-billable category header that requires additional characters to identify the cerebrovascular event type and the specific neurological deficit. I69.1 (Sequelae of nontraumatic intracerebral hemorrhage) is a non-billable subcategory requiring a fifth character to specify the sequela type. I69.19 (Other sequelae of nontraumatic intracerebral hemorrhage) is also non-billable and must be extended to a sixth-character code — such as I69.193 — before it is reportable on any claim.
Clinical Context
This code applies when a patient presents with ataxia — a disorder of voluntary muscle coordination, balance, and proprioception — that is the direct neurological consequence of a prior nontraumatic (spontaneous) intracerebral hemorrhage. The hemorrhagic event itself is no longer active; I69.193 captures only the residual functional deficit in a subsequent encounter. Clinical documentation must explicitly link the ataxia to the prior ICH to support this code rather than a primary ataxia code such as G11.9.
Code Classification
ICD-10 CM I69.193 is an ICD-10-CM diagnosis code, not a procedure or supply code. It is classified within the sequelae block of Chapter 9 (Diseases of the Circulatory System) and captures a late effect of a completed hemorrhagic cerebrovascular event. It is not used during the acute-phase ICH admission; active hemorrhagic strokes require codes from the I61 category.
🔍 Code Description
ICD-10 CM I69.193 captures the persistent neurological deficit of ataxia as a sequela of a prior nontraumatic intracerebral hemorrhage. Ataxia in this context refers to impaired voluntary coordination, balance, and sensory integration resulting from damage to cerebellar pathways, corticospinal tracts, or posterior column circuits following spontaneous bleeding into the brain parenchyma. The code is applicable across the full continuum of post-stroke care — from acute inpatient rehabilitation to long-term management hospitalizations — whenever the hemorrhagic event has resolved and the ataxia represents the residual deficit. This code does not describe the active bleeding episode; if an acute new hemorrhage occurs in the same admission, I61.x is coded separately as the acute condition.1,2
Nontraumatic intracerebral hemorrhage most commonly results from hypertensive vasculopathy, cerebral amyloid angiopathy, coagulopathy related to anticoagulant therapy, or arteriovenous malformations. The location of the original hemorrhage — cerebellar, pontine, thalamic, lobar, or basal ganglia — directly drives the type and severity of residual deficits. Cerebellar and posterior fossa ICH disproportionately produces ataxic sequelae, including truncal ataxia, limb ataxia, and gait disturbance, making I69.193 a high-frequency code in PM&R inpatient rehabilitation, neurology follow-up admissions, and IRF qualifying diagnosis assignment. In complex patients, I69.193 should be coded alongside all other documented I69.1xx deficit codes — such as I69.191 for dysphagia or I69.151 for hemiplegia — to fully reflect the neurological burden.2,3
🌳 Code Tree / Hierarchy
I69 — Sequelae of cerebrovascular disease ❌ Non-billable
│
├── I69.0 — Sequelae of nontraumatic subarachnoid hemorrhage ❌ Non-billable
│ └── I69.093 — Ataxia following nontraumatic SAH ✅ Billable
│
├── I69.1 — Sequelae of nontraumatic intracerebral hemorrhage ❌ Non-billable
│ │
│ ├── I69.10 — Unspecified sequelae of nontraumatic ICH ✅ Billable
│ ├── I69.15x — Hemiplegia/hemiparesis following nontraumatic ICH ❌ Non-billable
│ │ ├── I69.151 — Affecting right dominant side ✅ Billable
│ │ └── I69.152 — Affecting left dominant side ✅ Billable
│ │
│ └── I69.19 — Other sequelae of nontraumatic ICH ❌ Non-billable
│ ├── I69.190 — Apraxia following nontraumatic ICH ✅ Billable
│ ├── I69.191 — Dysphagia following nontraumatic ICH ✅ Billable
│ ├── I69.192 — Facial weakness following nontraumatic ICH ✅ Billable
│ ├── I69.193 — Ataxia following nontraumatic ICH ◀ THIS CODE ✅ Billable
│ └── I69.198 — Other sequelae of nontraumatic ICH ✅ Billable
│
├── I69.3 — Sequelae of cerebral infarction ❌ Non-billable
│ └── I69.393 — Ataxia following cerebral infarction ✅ Billable
│
└── I69.9 — Sequelae of unspecified cerebrovascular disease ❌ Non-billable
└── I69.993 — Ataxia following unspecified cerebrovascular disease ✅ BillableWhy Specificity at I69.193 vs. I69.198 Matters
Selecting I69.193 (ataxia) over the catch-all I69.198 (other sequelae) is critical because ataxia is a named, clinically specific deficit with its own rehabilitation billing pathway and PT/OT treatment justification. Payers and quality programs track sequelae specificity; vague “other sequelae” coding may trigger clinical validation audits or DRG queries when therapeutic exercise and gait training codes are billed alongside it.
Tip
Multiple I69.1xx codes may be reported simultaneously for the same patient. If a post-ICH patient presents with both ataxia (I69.193) and dysphagia (I69.191), both codes are separately reportable and clinically appropriate — they are not mutually exclusive within the I69.1 family. Stacking all documented deficit codes most accurately reflects neurological complexity and supports therapy authorization and DRG accuracy.
✅ Includes
- Ataxia that is the direct late effect of a prior spontaneous intracerebral hemorrhage — including hypertensive ICH, cerebral amyloid angiopathy-related ICH, and coagulopathy-related ICH2
- Cerebellar ataxia, truncal ataxia, limb ataxia, and gait ataxia attributable to the established post-ICH neurological state
- Coordination deficits and balance impairment documented as sequelae of a prior nontraumatic ICH, even when the original hemorrhage occurred months or years prior to the current encounter1
❌ Excludes
Excludes 1
S06.- (Intracranial injury) — Ataxia resulting from traumatic brain injury must be coded from the S06 injury chapter, not the I69 cardiovascular sequelae block; these two families are mutually exclusive by Excludes 1 notation. A patient cannot have both a traumatic TBI sequela and a nontraumatic ICH sequela captured under I69 for the same neurological deficit in the same encounter. Documentation must clearly distinguish spontaneous hemorrhage from trauma-related hemorrhage to select the correct code family.1
I61.- (Nontraumatic intracerebral hemorrhage, active) — The acute hemorrhage codes are excluded from simultaneous use with I69.193 as cause and sequela in the same context; I69.193 is reserved for subsequent encounters after the acute phase has resolved. If the patient remains in the acute-phase ICH admission, I61.x codes apply, not I69.193, and using the sequela code prematurely misrepresents the episode of care.1,2
Danger
The most common Excludes 1 error is applying I69.193 during the active ICH hospitalization (I61.x encounter), rather than a subsequent encounter for sequelae management. Assigning I69.193 during the acute bleed episode misrepresents the clinical picture, incorrectly groups the DRG, and may trigger medical necessity denials or integrity audits.
Excludes 2
ICD-10 CM G11.9 (Hereditary ataxia, unspecified) — If a patient has a known hereditary ataxia AND a prior ICH with ataxia as a documented sequela, both G11.9 and I69.193 may be coded when each is independently supported by physician documentation. The distinction between hereditary ataxia and acquired post-ICH ataxia must be explicitly addressed in the record; a CDI query to the attending is strongly recommended when both conditions are present.
📋 Clinical Overview
Ataxia Subtype and Hemorrhage Location: A Coding-Relevant Distinction
The presentation of ataxia following ICH varies substantially by hemorrhage location, and detailed provider documentation of both the prior bleed site and the current ataxia subtype significantly strengthens I69.193 coding integrity. Cerebellar ICH most commonly produces truncal and gait ataxia, thalamic or posterior capsule bleeds may produce sensory ataxia, and pontine ICH often produces ataxia co-occurring with dysphagia and facial weakness. Coders should look for PT and OT documentation referencing balance deficits, dysmetria, coordination impairment, or positive Romberg findings as clinical support for this code, while noting that ancillary provider documentation alone is insufficient — physician linkage to the prior ICH is required.
| Feature | I69.193 | I69.191 | I69.190 |
|---|---|---|---|
| Deficit Type | Ataxia — loss of voluntary muscle coordination, balance, and proprioception following nontraumatic ICH | Dysphagia — swallowing difficulty or inability to swallow safely following nontraumatic ICH | Apraxia — impaired ability to execute learned, purposeful movements despite intact motor and sensory function following nontraumatic ICH |
| Common ICH Location | Cerebellar, posterior fossa, thalamic, and posterior capsule hemorrhages most commonly produce ataxia; pontine bleeds may also contribute | Brainstem and cortical ICH affecting swallowing centers; supratentorial bleeds impacting corticobulbar tracts | Frontal and parietal ICH disrupting praxis networks; less commonly from subcortical hemorrhage |
| Rehabilitation Impact | Drives PT (gait and balance), OT (ADL coordination), and vestibular therapy; frequently the qualifying condition for IRF admission | Drives SLP services including modified diet, PEG evaluation, and modified barium swallow; significantly impacts LOS and discharge planning | Drives OT referral for task retraining targeting self-care, ADL independence, and motor planning; may require extended inpatient stay |
| CDI Trigger | Query if provider documents only “balance problems,” “coordination deficit,” or “dizziness” without explicitly naming ataxia as the post-ICH sequela | Query if only “difficulty eating” or “aspiration risk” is documented without a formal dysphagia diagnosis | Query if only “confusion” or “clumsiness with tasks” is documented without specific motor planning deficit terminology |
Important
If the physician documents “cerebellar dysfunction,” “coordination deficit,” or “gait disturbance post-ICH” but does not explicitly use the term “ataxia,” a CDI query is warranted before assigning I69.193. Inpatient coders cannot infer ataxia from these descriptors alone under UHDDS diagnostic reporting guidelines — physician confirmation in the record is required.
Manifestations & Symptom Burden
- Gait ataxia — Wide-based, staggering, unsteady gait pattern; patient may be unable to ambulate safely without an assistive device or human assistance; primary driver for PT referral and inpatient fall-risk precaution protocols
- Limb ataxia — Dysmetria on finger-to-nose and heel-to-shin testing; intention tremor; impaired fine motor coordination; directly impacts ADL performance and OT therapy goal-setting
- Truncal ataxia — Inability to maintain stable sitting or standing posture without external support; frequently co-occurs with limb ataxia after cerebellar ICH and may complicate routine nursing care and positioning
- Ocular motor involvement — Nystagmus, gaze instability, or oscillopsia may accompany cerebellar ICH sequelae and should be coded separately when documented (e.g., H55.00 for unspecified nystagmus)
- Dysarthria co-occurrence — Slurred or scanning speech due to cerebellar pathway involvement frequently co-occurs with ataxia after posterior fossa ICH; document and code separately as an additional sequela when present and confirmed by physician
Tip
When ataxia and dysphagia coexist after posterior fossa or pontine ICH, it is both appropriate and essential to report I69.193 and I69.191 together. CDI teams should routinely query for the full neurological sequelae burden in these patients; stacking specific I69.1xx codes more accurately reflects clinical complexity and may influence CC/MCC counting when combined with other comorbidities on the claim.
💰 HCC Risk Adjustment
| HCC Model | HCC Category | Mapped | RAF Contribution |
|---|---|---|---|
| CMS HCC v28 (current) | N/A | ❌ No direct HCC mapping | None for I69.193 alone |
| CMS HCC v24 (legacy) | N/A | ❌ No direct HCC mapping | None for I69.193 alone |
| Commercial / ACA | Varies by plan | Verify with payer | Plan-specific |
ICD-10 CM I69.193 itself does not carry a direct HCC mapping under CMS v28 or v24 models. However, co-occurring I69.1xx sequelae codes documented in the same patient may carry significant HCC weight — specifically, I69.151 and I69.152 (hemiplegia/hemiparesis following nontraumatic ICH) map to HCC 100, which carries meaningful RAF contribution. CDI and coding teams should ensure that all concurrent neurological deficits, including hemiplegia, aphasia, and dysphagia, are independently documented and coded alongside I69.193 to maximize legitimate RAF capture. For Medicare Advantage patients, annual recapture of all I69 sequelae codes is required, as sequelae do not auto-populate between plan years.4
🏥 MS-DRG Assignment
| Scenario | DRG | Title | Relative Weight (approx.) |
|---|---|---|---|
| I69.193 as PDX + MCC present | 056 | Degenerative Nervous System Disorders with MCC | ~1.9-2.1 |
| I69.193 as PDX, no CC/MCC | 057 | Degenerative Nervous System Disorders without CC/MCC | ~0.85-1.0 |
| IRF admission (qualifying dx) | IRF-CMG | IRF-PAI grouping applies — I69.193 as etiologic dx | Case mix group |
When I69.193 is sequenced as the principal diagnosis, the case groups to MDC 01 (Diseases and Disorders of the Nervous System) and lands in DRG 056 (with MCC) or DRG 057 (without CC/MCC); there is no separate CC tier in this DRG family. High-yield MCCs in this clinical population include aspiration pneumonia (J69.0), acute respiratory failure (J96.00), and severe protein-calorie malnutrition (E43). Coders should not confuse I69.193 with acute hemorrhagic stroke codes from the I61 family, which route to the stroke-specific DRG 061-066 cluster and carry distinct reimbursement weight. When I69.193 is used as a secondary diagnosis rather than PDX, it does not independently shift DRG assignment unless it qualifies as a CC under facility-specific grouper logic — confirm with internal CC/MCC table. For IRF admissions, I69.193 serves as the qualifying etiologic diagnosis supporting the rehabilitation need; the IRF-PAI CMG system then drives case mix grouping independently of MS-DRG.3,5
🔗 Related ICD-10-CM Codes
Ataxia Sequelae — Parallel Codes Across Cerebrovascular Event Types
- I69.093 — Ataxia following nontraumatic subarachnoid hemorrhage
- I69.393 — Ataxia following cerebral infarction (ischemic stroke — critical etiology differential)
- I69.893 — Ataxia following other cerebrovascular disease
- I69.993 — Ataxia following unspecified cerebrovascular disease
Other Sequelae Within the I69.1 Family
- I69.190 — Apraxia following nontraumatic intracerebral hemorrhage
- I69.191 — Dysphagia following nontraumatic intracerebral hemorrhage
- I69.192 — Facial weakness following nontraumatic intracerebral hemorrhage
- I69.151 — Hemiplegia and hemiparesis following nontraumatic ICH, right dominant side
- I69.198 — Other sequelae of nontraumatic intracerebral hemorrhage
🛠️ Commonly Associated CPT Codes
- 97110 — Therapeutic exercises; addresses strength and coordination deficits in ataxic limb and trunk musculature; billed per 15-minute unit by PT; among the most frequently paired CPT codes with I69.193 in inpatient and IRF settings
- 97116 — Gait training; directly targets ambulatory deficits associated with post-ICH ataxia, including balance retraining, step sequencing, and fall prevention strategies; billed separately from 97110 when distinct therapeutic goals and skills are performed
- 97530 — Therapeutic activities; addresses functional task performance impaired by cerebellar or motor pathway disruption from ICH; OT-driven code used when coordination deficits impair ADL performance in the inpatient setting
- 92521 — Evaluation of speech sound production; relevant when dysarthria co-occurs with ataxia following posterior fossa or cerebellar ICH; performed by SLP and reported as a separately billable evaluation service
- 96116 — Neurobehavioral status examination; applicable when neuropsychology or neurology assesses cognitive and behavioral sequelae in complex post-ICH patients; may co-occur with ataxia evaluation in multidisciplinary inpatient workups
- 97150 — Therapeutic procedures, group setting; reportable when inpatient rehabilitation delivers group balance or coordination therapy; requires documentation clearly distinguishing group from individual treatment time
NCCI Bundling Considerations
CPT codes 97110, 97116, and 97530 are subject to NCCI edit review when billed together on the same date of service without distinct time and service documentation supporting separately identifiable therapeutic goals. Each code must represent a unique, documented service with its own functional objective; therapy notes must support separate unit billing with time tracking. Group therapy (97150) may not be billed on the same date as individual therapeutic exercises (97110) for the same patient without clear service-level separation documented in the treatment record.6
🔬 ICD-10-PCS Crosswalk
- F07C0ZZ — Motor Treatment, Speech (Section F — Physical Rehabilitation and Diagnostic Audiology); applicable when dysarthria co-occurs with ataxia and SLP is addressing motor speech deficits in the inpatient rehabilitation setting following cerebellar or posterior fossa ICH
- F07L0ZZ — Activities of Daily Living Treatment, Motor Function; used when OT addresses upper extremity coordination deficits in functional task performance attributable to post-ICH ataxia; maps to rehabilitation work targeting dysmetria and fine motor impairment
- F07D6EZ — Gait and/or Balance Treatment using Orthosis (Neurological Treatment); applicable when PT addresses ambulatory deficits and postural control related to truncal or gait ataxia and an assistive orthosis is incorporated into the treatment session
- GZJ2ZZZ — Counseling, Individual (Mental Health section); applicable when the psychosocial burden of post-ICH ataxia — including adjustment disorder or depression related to functional loss — is addressed by a licensed mental health clinician during the same inpatient stay
💊 Coding Scenarios and Examples
Scenario 1 — PM&R IRF Admission for Post-ICH Gait Ataxia A 68-year-old male with a history of hypertensive cerebellar ICH 4 months prior presents for inpatient rehabilitation. He exhibits wide-based gait, a positive Romberg sign, bilateral dysmetria on heel-shin testing, and is unable to ambulate independently. PT documents “gait ataxia and limb ataxia secondary to prior cerebellar hemorrhage.” Neuroimaging confirms no new acute bleed.
- Principal Dx: I69.193 — Ataxia following nontraumatic intracerebral hemorrhage
- Secondary Dx: I10 — Essential (primary) hypertension
- Sequencing: I69.193 leads as the qualifying etiologic diagnosis driving IRF admission; I10 is the supporting contributing comorbidity
- CDI Note: Confirm that the attending physician explicitly documents “ataxia” rather than only “coordination deficit” or “balance impairment” — initiate a query if the physician documentation uses only nonspecific descriptors
Scenario 2 — Inpatient Neurology Admission with Stacked I69.1xx Sequelae and MCC A 74-year-old female with a prior pontine ICH 6 months earlier presents with progressive dysphagia and balance impairment leading to aspiration pneumonia requiring acute inpatient admission. The attending documents ataxia and neurogenic dysphagia as documented residual deficits of the prior hemorrhage.
- Principal Dx: J69.0 — Pneumonitis due to solids and liquids (aspiration pneumonia — reason for this admission)
- Secondary Dx: I69.193 — Ataxia following nontraumatic intracerebral hemorrhage
- Secondary Dx: I69.191 — Dysphagia following nontraumatic intracerebral hemorrhage
- Secondary Dx: I10 — Essential (primary) hypertension
- Sequencing: J69.0 leads as the acute condition driving this admission; I69.193 and I69.191 are separately reportable sequelae that increase clinical burden and should be evaluated against the facility CC/MCC table for DRG impact
- CDI Note: J69.0 as PDX combined with stacked I69.1xx comorbidities is a high-yield DRG complexity scenario; confirm all sequelae are explicitly supported by physician documentation in this encounter
Scenario 3 — Documentation Integrity: Ataxia vs. Unspecified Balance Deficit Post-ICH A 71-year-old male recovering from a prior left basal ganglia ICH presents for follow-up. The discharge summary reads: “patient has balance and walking difficulties.” The PT note documents “uncoordinated wide-based gait and truncal instability consistent with ataxic presentation.” The attending physician has not used the word “ataxia” anywhere in the record.
- Correct Action: Issue a compliant CDI query to the attending asking whether the clinical presentation represents ataxia (I69.193), hemiplegia/hemiparesis (I69.151 or I69.152), or another specific deficit — citing PT findings as the basis for the query
- Do NOT code: I69.193 based on PT documentation alone; under UHDDS guidelines, inpatient coders cannot assign diagnoses from ancillary provider notes without attending physician confirmation in the record
- CDI Note: This is a high-yield query opportunity — clarifying “ataxia” from “balance difficulty post-ICH” is clinically supported, compliance-appropriate, and directly impacts code specificity, therapy medical necessity, and future HCC/RAF capture1,5
⚠️ Coding Pitfalls and Tips
- Do not use I69.193 during the acute ICH hospitalization — Sequelae codes in the I69 family apply only in subsequent encounters after the acute hemorrhagic event has concluded; if the patient is still in the initial ICH admission, I61.x codes apply and I69.193 is not appropriate in that same episode.1
- Distinguish hemorrhagic from ischemic etiology — I69.393 captures ataxia following cerebral infarction (ischemic stroke), while I69.193 is specific to nontraumatic intracerebral hemorrhage; review prior discharge summaries, neuroimaging reports, or query the provider to confirm the hemorrhagic vs. ischemic mechanism before code selection.
- Stack all documented sequelae — Multiple I69.1xx codes can and should be reported concurrently when clinically supported; limiting to a single sequela code when the patient also has dysphagia (I69.191) or hemiplegia (I69.151) understates clinical complexity and may result in lost **CC/MCC capture **that affects DRG weight.
- Ataxia ≠ dizziness, vertigo, or unsteadiness — Provider documentation using only “dizziness,” “vertigo,” or “unsteadiness” does not automatically support I69.193; if only nonspecific symptom language appears, report symptom codes such as R42 or R26.81 unless the physician explicitly links the balance disturbance to ataxia as a post-ICH sequela.2
- I69.10 is available but clinically imprecise — If the provider cannot be queried and only unspecified sequelae can be supported, I69.10 is billable but carries no specificity value for therapy authorization, quality reporting, or CDI benchmarking; always attempt a compliant query before defaulting to the unspecified code.
- IRF etiologic diagnosis requirements — For IRF admission, I69.193 should be listed as the etiologic diagnosis on the IRF-PAI; the post-ICH ataxia must be of sufficient severity to require intensive, multidisciplinary rehabilitation, and the admitting physician’s post-admission evaluation must explicitly document this clinical necessity.3