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I69.222

Properties3
codeI69.222
code_titleDysarthria following other nontraumatic intracranial hemorrhage
statusActive ✅

17 min read

🧬 ICD-10 CM I69.222 — Dysarthria Following Other Nontraumatic Intracranial Hemorrhage

Billable Code Confirmed

ICD-10 CM I69.222 is a valid, fully billable 7-character ICD-10-CM code for FY2026. The sixth character “2” specifies dysarthria, and this falls under subcategory I69.22 (Speech and language deficits following other nontraumatic intracranial hemorrhage), making it complete with sufficient clinical specificity for claim submission. No additional characters are required.

Non-Billable Parent Codes

I69 (Sequelae of cerebrovascular disease) is a non-billable category header — it lacks the specificity required to identify the type of deficit or the causative hemorrhage subtype, and cannot be submitted on a claim. I69.2 (Sequelae of other nontraumatic intracranial hemorrhage) is a non-billable block header — it narrows the event type but does not identify the specific neurological sequela, requiring further character extension. I69.22 (Speech and language deficits following other nontraumatic intracranial hemorrhage) is a non-billable subcategory — it identifies the general deficit category (speech/language) but does not specify the type of deficit (aphasia vs. dysarthria vs. fluency disorder), requiring the 7th character for a billable code.

Clinical Context

Dysarthria is a motor speech disorder caused by disruption of the neuromuscular control of the vocal tract, distinct from aphasia (a language processing disorder) and dysphasia (a language formulation difficulty). The “other nontraumatic” qualifier in I69.222 refers to hemorrhagic events classified under I62 (other nontraumatic intracranial hemorrhage), such as subdural or epidural hematomas, as opposed to subarachnoid hemorrhage (I60) or intracerebral hemorrhage (I61), each of which has its own parallel sequela code track.

Code Classification

ICD-10 CM I69.222 is a diagnosis code in ICD-10-CM, specifically a sequela (late effect) code. It is not a procedure code (ICD-10-PCS) and not a CPT/HCPCS code. This code is POA (Present on Admission) exempt because, by definition, sequelae codes represent conditions that developed as a result of a prior event and are not acute admitting diagnoses.

🔍 Code Description

ICD-10 CM I69.222 reports the residual neurological deficit of dysarthria that persists as a sequela following a nontraumatic intracranial hemorrhage classified under category I62 (other and unspecified nontraumatic intracranial hemorrhage). Dysarthria is a motor speech disorder resulting from damage to the neural pathways controlling the muscles of articulation, phonation, resonance, and respiration — producing slurred, slow, or imprecise speech that is fully distinct from a language-processing deficit like Aphasia. The “other nontraumatic” designation is critical for code selection and differentiates this subcategory from sequelae of subarachnoid hemorrhage (I69.0x series) and intracerebral hemorrhage (I69.1x series), and from sequelae of Cerebral Infarction (I69.3x series).

Category I69 sequela codes do not require a time interval to have elapsed since the original event — the sequela may be present at the time of the initial event or may develop and persist afterward. For inpatient facility coding, I69.222 may appear as a principal diagnosis when the sole reason for the admission is management or rehabilitation of post-hemorrhagic dysarthria (e.g., inpatient rehab unit admission), or it may appear as a secondary code alongside an active unrelated principal diagnosis. Coders working in profee settings should note that speech-language pathology evaluation and treatment services (CPT 92507, 92521-92524) should align with a supporting diagnosis such as I69.222 to demonstrate medical necessity.

🌳 Code Tree / Hierarchy

I69 — Sequelae of cerebrovascular disease ❌ Non-billable
│
├── I69.0 — Sequelae of nontraumatic subarachnoid hemorrhage ❌ Non-billable
│   └── I69.020 — Aphasia following nontraumatic subarachnoid hemorrhage ✅ Billable
│
├── I69.1 — Sequelae of nontraumatic intracerebral hemorrhage ❌ Non-billable
│   └── I69.122 — Dysarthria following nontraumatic intracerebral hemorrhage ✅ Billable
│
├── I69.2 — Sequelae of other nontraumatic intracranial hemorrhage ❌ Non-billable
│   │
│   └── I69.22 — Speech and language deficits following other nontraumatic intracranial hemorrhage ❌ Non-billable
│       │
│       ├── I69.220 — Aphasia following other nontraumatic intracranial hemorrhage ✅ Billable
│       ├── I69.221 — Dysphasia following other nontraumatic intracranial hemorrhage ✅ Billable
│       ├── I69.222 — Dysarthria following other nontraumatic intracranial hemorrhage ◀ THIS CODE ✅ Billable
│       └── I69.223 — Fluency disorder 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

Why I69.222 and Not I69.122 or I69.322?

The hemorrhage subtype is the entire axis of differentiation here — I69.122 follows intracerebral hemorrhage (I61), I69.222 follows other nontraumatic intracranial hemorrhage (I62), and I69.322 follows cerebral infarction (I63). Selecting the wrong parent event type is one of the most common sequela coding errors and can trigger medical necessity denials or audits, particularly in post-acute and rehab settings where payers cross-reference the historical acute event.

Tip

When querying the Alphabetic Index, look up “Dysarthria” → “following” → “cerebrovascular disease” and then specify the hemorrhage type, or enter “Sequelae” → “hemorrhage, intracranial” → “other nontraumatic” → “dysarthria” to arrive at I69.222. Always verify in the Tabular List to confirm excludes notes before finalizing code assignment.

✅ Includes

  • Dysarthria resulting from any nontraumatic intracranial hemorrhagic event classified under I62 (Other and unspecified nontraumatic intracranial hemorrhage), including subdural hemorrhage not classified as traumatic and hemorrhage of unspecified intracranial origin when nontraumatic.
  • Motor speech impairment manifesting as slurred articulation, hypernasality, reduced intelligibility, or dysphonic quality attributable to the neurological sequela of the hemorrhage.
  • Speech deficits documented by the treating provider as persistent or residual following the intracranial hemorrhagic event, regardless of time elapsed since the event.

❌ Excludes

Excludes 1

S06.- (Sequelae of traumatic intracranial injury) — This is an Excludes 1 relationship, meaning I69.222 and a traumatic intracranial sequela code cannot be reported together on the same claim for the same episode of care. If the intracranial hemorrhage was caused by trauma (e.g., fall, MVA), the sequela must be captured under the S06 series, not I69. Always verify the etiology of the original hemorrhage in the health record before assigning I69.222, as misclassifying a traumatic event as nontraumatic constitutes a coding error.

Danger

The most frequent Excludes 1 error with I69.222 is assigning it when the underlying intracranial hemorrhage was, in fact, traumatic in origin — particularly in fall-related subdural hematomas in elderly patients where “nontraumatic” language may appear in the note but the mechanism was a fall. Always trace the original causative event in the history and confirm the attending’s clinical characterization of the hemorrhage type.

Excludes 2

ICD-10 CM Z86.73 (Personal history of cerebral infarction without residual deficit) — This is an Excludes 2 note, indicating these codes can be reported together when applicable. If a patient has a prior history of cerebral infarction (separately from the nontraumatic intracranial hemorrhage that caused the dysarthria) and that infarction left no residual deficit, Z86.73 may be coded additionally to document the complete clinical picture without conflicting with I69.222.

📋 Clinical Overview

Dysarthria vs. Other Post-Hemorrhagic Speech/Language Deficits

Differentiating dysarthria from aphasia and dysphasia is a critical CDI opportunity because the codes carry different clinical implications for rehabilitation planning, payer criteria, and SLP service justification. Dysarthria (I69.222) represents a pure motor execution problem — the patient knows what they want to say but cannot physically produce the sounds with normal clarity or fluency. In contrast, I69.220 (aphasia) represents a central language processing failure affecting comprehension and/or expression, and I69.221 (dysphasia) represents a partial or milder language formulation deficit. Clinical documentation must clearly distinguish which deficit is present to support accurate code selection.

FeatureI69.222I69.220I69.221
Deficit TypeMotor speech execution; muscles of articulation impairedCentral language processing failure; expression and/or comprehension affectedPartial language formulation difficulty; less severe than aphasia
Patient AwarenessPatient knows what they want to say; execution is impairedPatient may not know correct words or understand languagePatient has difficulty finding words but retains partial ability
SLP Treatment FocusArticulation drills, respiratory support, AAC devicesLanguage therapy, word retrieval, comprehension tasksLanguage facilitation, word-finding strategies
CDI Trigger”Slurred speech,” “unclear articulation,” “reduced intelligibility""Can’t find words,” “doesn’t understand commands,” “word salad""Word-finding difficulty,” “hesitant speech,” “paraphasia”
HCC MappingNot HCC-mappedNot HCC-mappedNot HCC-mapped

Important

A strong CDI trigger for I69.222 is any SLP note that documents “dysarthric speech,” “reduced articulatory precision,” or “slurred speech secondary to neurological deficit.” Ensure the attending or neurologist has linked the dysarthria explicitly to the prior hemorrhagic event in the assessment/plan rather than leaving it as an incidental finding without causal attribution.

Manifestations & Symptom Burden

  • Reduced speech intelligibility — The patient’s articulation is impaired to varying degrees, ranging from mildly slurred speech to near-unintelligible output, depending on the location and extent of the hemorrhagic lesion.
  • Hypernasality or hyponasality — Damage to velopharyngeal musculature control can result in abnormal nasal resonance during speech, a hallmark of certain dysarthria subtypes (e.g., flaccid or mixed dysarthria).
  • Dysphonia — Vocal quality abnormalities such as breathiness, harshness, or reduced loudness may co-occur due to laryngeal motor involvement, requiring concurrent SLP and potentially ENT evaluation.
  • Dysphagia — Motor speech impairment and swallowing dysfunction frequently co-occur following intracranial hemorrhage, as the same neural structures that control articulation also govern pharyngeal swallowing; always assess for concurrent R13.10 (dysphagia, unspecified) or more specific dysphagia codes.
  • Cognitive-communication deficits — Executive function impairments, reduced attention, and processing speed issues may compound the motor speech deficit and complicate SLP treatment planning.

Tip

When dysarthria co-occurs with dysphagia following the same hemorrhagic event, both I69.222 and the applicable dysphagia code (e.g., R13.10 or R13.11-R13.19) may be reported together — these are not in an Excludes relationship. In fact, capturing dysphagia separately is critical for MS-DRG optimization, as dysphagia with documented aspiration risk can support a higher-acuity secondary diagnosis and impact care level justification for inpatient vs. observation status.

💰 HCC Risk Adjustment

ModelHCC CategoryHCC LabelRAF Weight
CMS-HCC v24Not mappedN/A0.000
CMS-HCC v28Not mappedN/A0.000
HHS-HCC v08Not mappedN/A0.000

ICD-10 CM I69.222 does not carry a direct HCC mapping in any current CMS risk adjustment model — dysarthria as a standalone sequela is not considered a high-risk, high-cost condition for RAF scoring purposes. However, when this code is documented alongside HCC-mapped neurological sequelae (e.g., hemiplegia codes I69.351-I69.354 which map to HCC 103 under v24 and HCC 253 under v28), the overall RAF score for the patient can still be significantly elevated. Coders and CDI specialists should ensure all applicable HCC-mapped co-conditions are captured when I69.222 is present, as these patients often carry a high clinical burden that may be underrepresented if only the speech deficit is documented.

🏥 MS-DRG Assignment

CC/MCC StatusMS-DRGTitleRelative Weight (approx.)
With MCCDRG 020Intracranial Vascular Procedures with PDX Hemorrhage with MCCHigh
With CCDRG 065Intracranial Hemorrhage or Cerebral Infarction with CC or tPA in 24 HoursModerate
Without CC/MCCDRG 066Intracranial Hemorrhage or Cerebral Infarction without CC/MCCLower
Rehab setting (PDX)DRG 945Rehabilitation with CC/MCCVariable
Rehab setting (PDX)DRG 946Rehabilitation without CC/MCCVariable

When I69.222 is used as a secondary diagnosis in an acute stroke admission, it does not carry CC or MCC status and therefore will not independently shift the MS-DRG. When used as a principal diagnosis for a rehabilitation admission focused on post-hemorrhagic speech deficits, it will typically route to MDC 01 or to rehabilitation DRGs 945/946 depending on the setting. Coders should verify the admit type and setting (acute vs. IRF vs. LTACH) before sequencing I69.222 as PDX, as IRF coding follows different rules under CMS IRF-PAI requirements. In inpatient acute settings, the presence of high-weight secondary diagnoses such as aspiration pneumonia (J69.0) — a common comorbidity in dysarthric patients — can significantly elevate the DRG weight even when I69.222 itself carries no CC/MCC designation.

🔗 Related ICD-10-CM Codes

Parallel Dysarthria Sequela Codes by Event Type

  • I69.022 — Dysarthria following nontraumatic subarachnoid hemorrhage
  • I69.122 — Dysarthria following nontraumatic intracerebral hemorrhage
  • I69.322 — Dysarthria following cerebral infarction
  • I69.822 — Dysarthria following other cerebrovascular disease
  • I69.922 — Dysarthria following unspecified cerebrovascular disease

Commonly Co-Coded Conditions

  • R13.10 — Dysphagia, unspecified (commonly co-occurs with dysarthria in post-hemorrhagic patients)
  • R47.1 — Dysarthria and anarthria (use when dysarthria is not linked to a specific prior CVA/hemorrhage event; not for sequela coding)
  • I69.220 — Aphasia following other nontraumatic intracranial hemorrhage (sibling code when language processing also impaired)
  • I69.221 — Dysphasia following other nontraumatic intracranial hemorrhage
  • I69.223 — Fluency disorder following other nontraumatic intracranial hemorrhage
  • Z87.39 — Personal history of other endocrine, nutritional and metabolic diseases (may be relevant contextually)
  • I62.9 — Nontraumatic intracranial hemorrhage, unspecified (the acute event code that precedes this sequela)

🛠️ Commonly Associated CPT Codes

92507 — Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual. This is the most commonly billed SLP treatment CPT for dysarthria management and should be supported by I69.222 as the primary or supporting diagnosis to demonstrate medical necessity for ongoing therapy services.

92521 — Evaluation of speech fluency (e.g., stuttering, cluttering). While primarily used for fluency disorders, this may be co-billed when a formal fluency assessment is needed alongside dysarthria evaluation to differentiate I69.222 from I69.223; documentation must support a distinct evaluation of fluency rather than bundling it into a general speech eval.

92522 — Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria). This is the most directly mapped CPT to I69.222 — formal evaluation of speech sound production in a dysarthric patient post-hemorrhage should be captured with 92522, supported by **I69.22**2 as medical necessity.

92524 — Behavioral and qualitative analysis of voice and resonance. When post-hemorrhagic dysarthria includes a hypernasality or dysphonia component, 92524 captures the resonance/voice assessment component, and I69.222 provides the underlying neurological basis for the evaluation.

97535 — Self-care/home management training (e.g., activities of daily living and compensatory training, meal preparation, safety procedures, instructions in use of adaptive equipment). For dysarthric patients being discharged home with AAC (augmentative and alternative communication) devices or trained in compensatory speech strategies, 97535 may be appropriate when OT or SLP provides ADL-related training.

99232 — Subsequent hospital inpatient or observation care (moderate complexity). Routine daily E&M visits during inpatient stays where dysarthria is actively managed as part of the post-hemorrhagic recovery plan; I69.222 supports the complexity of the neurological condition being managed.

NCCI Bundling Considerations

CPT 92507 (treatment) is typically not billable on the same date as 92522 (evaluation of speech sound production) when both are performed by the same provider in the same session, as the evaluation is considered part of the treatment planning process. Coders should ensure that evaluation and treatment CPTs are not double-billed on the same date without appropriate modifier support (e.g., Modifier -59 with documented distinct service). NCCI edits also prevent bundling 92521 and 92522 together without a modifier when both are reported on the same date by the same provider.

🔬 ICD-10-PCS Crosswalk

F00Z5EZ — Speech Treatment, Neurological System, Dysarthria. When dysarthria following intracranial hemorrhage is treated in an inpatient setting with formal speech therapy, this PCS code captures the speech treatment procedure and pairs with I69.222 on the facility claim to document the therapeutic intervention.

F01Z5EZ — Motor Treatment, Central Nervous System, Oral Motor Treatment. For patients receiving targeted oral motor exercises as part of a motor speech rehabilitation program in an inpatient rehab setting, this PCS code may apply when the focus is motor retraining of articulatory musculature rather than language therapy.

F0HZXEZ — Assessment, Central Nervous System, Speech and/or Language. This PCS assessment code is used when a formal SLP speech and language assessment is performed in the inpatient setting, capturing the diagnostic evaluation that supports I69.222 as an active problem being addressed during the hospitalization.

GZJ2ZZZ — Counseling, Group, Vocation/Educational. For patients receiving group communication therapy as part of an inpatient rehab program targeting post-hemorrhagic dysarthria, this PCS code captures the group intervention component.

💊 Coding Scenarios and Examples

Scenario 1: Inpatient Rehab Admission for Post-Hemorrhagic Dysarthria A 71-year-old female with a history of other nontraumatic intracranial hemorrhage three months ago presents to an inpatient rehabilitation facility for intensive speech therapy targeting her persistent dysarthria. She has slurred, low-intelligibility speech documented by SLP. No active hemorrhage. No hemiplegia.

  • Correct coding: I69.222 (PDX — dysarthria following other nontraumatic intracranial hemorrhage), I10 (HTN as secondary), Z87.39 as applicable history
  • Sequencing: I69.222 as PDX because it is the condition chiefly responsible for the rehabilitation admission.
  • CDI Note: Ensure the admitting and treating physicians explicitly link the dysarthria to the prior hemorrhagic event in the H&P and daily notes — do not assume the link without provider attribution.

Scenario 2: Acute Inpatient Stay with Active Comorbidities A 68-year-old male with a history of nontraumatic intracranial hemorrhage is admitted for aspiration pneumonia. SLP assessment confirms persistent dysarthria as a contributing factor to the aspiration event.

  • Correct coding: J69.0 (PDX — aspiration pneumonia), I69.222 (secondary — dysarthria as contributing factor), I10 (secondary — hypertension)
  • Sequencing: J69.0 as PDX because it is the acute condition responsible for the admission; I69.222 documents the underlying neurological etiology of aspiration risk.
  • CDI Note: Aspiration pneumonia (J69.0) carries MCC status in many DRG groupings — capturing this accurately can significantly elevate DRG weight. The link between dysarthria/dysphagia and the aspiration event should be explicitly stated by the provider.

Scenario 3: Outpatient Neurology Follow-Up (Profee) Crystal, as a profee coder you’ll recognize this one — a 65-year-old established patient follows up with neurology six months post nontraumatic intracranial hemorrhage. Neurologist documents persistent dysarthria and recommends continued SLP, but no new interventions are initiated today.

  • Correct coding: I69.222 (primary diagnosis for the visit), I10 (secondary — hypertension, chronic condition being monitored)
  • Sequencing: I69.222 as primary because the dysarthria is the reason for the visit as documented in the assessment.
  • CDI Note: Confirm the neurologist’s note explicitly states “dysarthria” and attributes it to the prior hemorrhage — vague language like “speech problems” without etiologic attribution does not support I69.222 per UHDDS and UACDS guidelines.

⚠️ Coding Pitfalls and Tips

  • Don’t confuse the hemorrhage subtype. [I69.222] is specifically for sequelae of “other nontraumatic intracranial hemorrhage” (I62). If the original event was intracerebral hemorrhage (I61), use I69.122; if subarachnoid hemorrhage (I60), use I69.022; if cerebral infarction (I63), use I69.322. Using the wrong parent event code is a frequent audit finding.
  • Don’t use R47.1 when a sequela code applies. R47.1 (Dysarthria and anarthria) is a symptom code appropriate only when dysarthria is not attributable to a known prior CVA or hemorrhage. When a provider has documented the causal relationship to a prior hemorrhagic event, I69.222 is the correct code — R47.1 would be an undercoding error.
  • Do not forget to capture concurrent dysphagia. Dysarthria and dysphagia frequently co-occur post-hemorrhage and are separately codeable. Failure to capture dysphagia with a specific code (e.g., R13.10, R13.11-R13.19) leaves clinical complexity and medical necessity support on the table, particularly for SLP services and care level justification.
  • Sequela codes do not require a waiting period. Per ICD-10-CM guidelines, there is no mandatory time interval between the acute hemorrhagic event and the assignment of a sequela code — if the deficit is documented as a residual effect, code it immediately. Do not hold the sequela code for a “later” visit.
  • POA assignment for I69.222 is always Exempt. Because sequela codes by definition represent conditions arising from a prior event, I69.222 is POA exempt — do not assign a POA indicator of “Y” or “N”; use the exempt designation per your facility’s guidelines to avoid claim-level edit errors.
  • Profee sequencing matters. In outpatient/profee settings, sequence the condition that is the primary reason for the encounter. If the neurology visit is solely to address the dysarthria, I69.222 is first-listed. If the visit addresses multiple issues, sequence per the provider’s documented reason for the encounter.

📚 Sources

  1. Centers for Disease Control and Prevention (CDC) / National Center for Health Statistics (NCHS). ICD-10-CM Official Guidelines for Coding and Reporting, FY2026. Section I.C.9.d — Sequelae of Cerebrovascular Disease. https://www.cdc.gov/nchs/icd/icd-10-cm.htm

  2. CMS. ICD-10-CM/PCS MS-DRG v43.1 Definitions Manual, FY2026. https://www.cms.gov/icd10m/FY2026-fr-v43.1-fullcode-cms/fullcode_cms/

  3. AAPC. ICD-10-CM Code I69.22 — Speech and language deficits following other nontraumatic intracranial hemorrhage. https://www.aapc.com/codes/icd-10-codes/I69.22

  4. Unbound Medicine. I69.220 — Aphasia following other nontraumatic intracranial hemorrhage (ICD-10-CM 2024). Includes hierarchy confirmation for I69.222. https://www.unboundmedicine.com/icd

  5. Medical Code Center. Billable ICD-10-CM Code I69.222 — Dysarthria following other nontraumatic intracranial hemorrhage. http://www.medicalcodecenter.com/coding/icd10Cm/book/code/I69222

  6. BCBS of Kansas. Coding Examples: Stroke or Cerebrovascular Accident (CVA) — ICD-10-CM Sequelae Coding Reference. (2023). https://www.bcbsks.com/documents/stroke-or-cerebrovascular-accident-marats-2023-05-01

  7. CMS. Risk Adjustment — Medicare Advantage Rates and Statistics. CMS-HCC v24 and v28 Model Documentation. https://www.cms.gov/medicare/payment/medicare-advantage-rates-statistics/risk-adjustment

  8. CDC ICD-10-CM Tool. Dysarthria Index Search — FY2022. https://icd10cmtool.cdc.gov/?fy=FY2022&query=dysarthria

  9. AHA Coding Clinic for ICD-10-CM and ICD-10-PCS. Sequelae of Cerebrovascular Disease — Coding Guidance. American Hospital Association, various issues.

  10. CMS. MS-DRG Classifications and Software — FY2026 IPPS Final Rule. https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/ms-drg-classifications-and-software

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