🧬 ICD-10 CM I69.293 — Ataxia Following Other Nontraumatic Intracranial Hemorrhage
Billable Code Confirmed
ICD-10 CM I69.293 is a fully billable, 7-character ICD-10-CM code valid for FY2026 HIPAA-covered transactions. The code structure breaks down as: I69 (sequelae of cerebrovascular disease) → .2 (other nontraumatic intracranial hemorrhage as the underlying cause) → 9 (other sequelae subcategory) → 3 (ataxia as the specific neurological manifestation). All seven characters are present and required, making this code complete and reportable without any additional specificity needed.
Non-Billable Parent Codes
I69 — Sequelae of cerebrovascular disease — is non-billable; it is the root category requiring all subsequent characters to specify the type of cerebrovascular event and the nature of the neurological sequela. I69.2 — Sequelae of other nontraumatic intracranial hemorrhage — is non-billable; the 5th character is missing and does not identify which type of neurological deficit resulted from the hemorrhagic event. I69.29 — Other sequelae of other nontraumatic intracranial hemorrhage — is non-billable; while the 5th character identifies the subcategory of sequelae, the 6th character specifying the exact neurological manifestation (in this case, ataxia = “3”) is still required to reach a billable level of specificity.
Clinical Context
ICD-10 CM I69.293 is selected specifically when a patient presents with ataxia — a neurological deficit characterized by loss of voluntary coordination of muscle movements — as a direct persistent sequela of a prior other nontraumatic intracranial hemorrhage, which includes subdural and epidural hemorrhages classified under I62. This code is distinct from I69.193 (ataxia following nontraumatic intracerebral hemorrhage) and I69.093 (ataxia following nontraumatic subarachnoid hemorrhage), so precise documentation of the hemorrhage type in the clinical record is critical for correct code assignment.
Code Classification
ICD-10 CM I69.293 is a diagnosis code (ICD-10-CM), not a procedure code. It is classified within Chapter 9 — Diseases of the Circulatory System — specifically in the cerebrovascular disease sequelae block, and it should never be used during the acute hospitalization for the index hemorrhagic event itself. This code applies to the residual neurological condition that persists after the initial acute phase of the nontraumatic intracranial hemorrhage has resolved.
🔍 Code Description
ICD-10 CM I69.293 captures the persistent neurological deficit of ataxia occurring as a sequela of a prior other nontraumatic intracranial hemorrhage — a category that encompasses subdural hematomas and other intracranial bleeds classified under I62. Per ICD-10-CM guidelines, category I69 is used specifically to indicate conditions in I60-I67 as the cause of a sequela; the sequelae themselves include any neurological deficit, whether present from the onset of the hemorrhage or arising at any time thereafter. The term “ataxia” in this context broadly refers to incoordination, gait disturbance, truncal unsteadiness, or limb dysmetria resulting from cerebellar or vestibular pathway disruption caused by the hemorrhagic insult.
The pathophysiological basis of post-hemorrhagic ataxia involves direct injury to cerebellar structures, disruption of corticospinal pathways, or compression of posterior fossa structures by blood products and subsequent edema. This residual deficit frequently persists long after the acute bleed resolves and may impact a patient’s functional independence, fall risk, and rehabilitation trajectory. Clinicians and CDI specialists should ensure that documentation clearly links the ataxia to the prior hemorrhagic event using causal language such as “ataxia due to prior subdural hemorrhage” or “cerebellar dysfunction as sequela of intracranial bleed,” since without explicit provider linkage, a coder cannot independently assign a sequela code per Official Guidelines for Coding and Reporting.
🌳 Code Tree / Hierarchy
I69 — Sequelae of cerebrovascular disease ❌ Non-billable
│
├── I69.0xx — Sequelae of nontraumatic subarachnoid hemorrhage ❌ Non-billable
│ └── I69.093 — Ataxia following nontraumatic subarachnoid hemorrhage ✅ Billable
│
├── I69.1xx — Sequelae of nontraumatic intracerebral hemorrhage ❌ Non-billable
│ └── I69.193 — Ataxia following nontraumatic intracerebral hemorrhage ✅ Billable
│
├── I69.2 — Sequelae of other nontraumatic intracranial hemorrhage ❌ Non-billable
│ │
│ ├── I69.20 — Unspecified sequelae of other nontraumatic intracranial hemorrhage ✅ Billable
│ ├── I69.21x — Cognitive deficits following other nontraumatic intracranial hemorrhage ❌ Non-billable
│ │ ├── I69.210 — Attention and concentration deficit ✅ Billable
│ │ └── I69.211 — Memory deficit ✅ Billable
│ ├── I69.29 — Other sequelae of other nontraumatic intracranial hemorrhage ❌ Non-billable
│ │ ├── I69.290 — Apraxia following other nontraumatic intracranial hemorrhage ✅ Billable
│ │ ├── I69.291 — Dysphagia following other nontraumatic intracranial hemorrhage ✅ Billable
│ │ ├── I69.292 — Facial weakness following other nontraumatic intracranial hemorrhage ✅ Billable
│ │ ├── I69.293 — Ataxia following other nontraumatic intracranial hemorrhage ◀ THIS CODE ✅ Billable
│ │ └── I69.298 — Other sequelae of other nontraumatic intracranial hemorrhage ✅ Billable
│
└── I69.3xx — Sequelae of cerebral infarction ❌ Non-billable
└── I69.393 — Ataxia following cerebral infarction ✅ Billable
The 4th character in I69 is the single most important character for specificity — it identifies the type of prior cerebrovascular event (subarachnoid hemorrhage = .0, intracerebral hemorrhage = .1, other intracranial hemorrhage = .2, cerebral infarction = .3). Misassigning I69.193 when the bleed was a subdural hematoma (I62) rather than an intracerebral hemorrhage (I61) constitutes a coding error that could trigger a RAC audit, so always trace back to the index admission diagnosis or imaging report to confirm.
Tip
When I69.293 is assigned for dysphagia sequela, the guidelines instruct you to also assign a code from R13.1- to identify the type of dysphagia — however, for ataxia, there is no mandatory “use additional code” instruction at I69.293, though R26.2 (Difficulty in walking) or R27.0 (Ataxia, unspecified) should NOT be separately coded as the I69.293 descriptor already encompasses the neurological manifestation per ICD-10-CM convention.
✅ Includes
- Ataxia as late effect of other nontraumatic intracranial hemorrhage — This term maps directly to I69.293 and should be recognized in provider documentation to trigger appropriate code assignment.
- Cerebellar sequela following subdural hematoma — When ataxia is documented as a residual neurological deficit following a prior subdural hematoma (I62.0x), this expression clinically aligns with I69.293 given that subdural hemorrhages are classified under the I62 block, which is the cause category for I69.2x sequelae.
- Gait incoordination as residual of prior nontraumatic intracranial bleed — Documented gait ataxia, truncal instability, or limb dysmetria attributed to a prior other nontraumatic intracranial hemorrhage falls under this code; coders should query for provider linkage if the causal relationship is implied but not explicitly stated.
❌ Excludes
Excludes 1
I62 — Other and unspecified nontraumatic intracranial hemorrhage (active/acute episode) — I62 codes represent the active, acute hemorrhagic event itself and are mutually exclusive with I69.2x codes; you cannot assign both I62.xx and I69.2xx simultaneously for the same hemorrhagic episode. The I69.2x codes are reserved for use after the acute phase has concluded and a neurological deficit persists as a sequela, making these two code families clinically and temporally distinct. I61 — Nontraumatic intracerebral hemorrhage — This block is the cause category for I69.1x (not I69.2x) sequelae; assigning I69.293 when the source bleed was an intracerebral hemorrhage (I61) rather than an other intracranial hemorrhage (I62) would be an incorrect combination and represents a misclassification of the causative event.
Danger
The most common Excludes 1 error with I69.293 is assigning it during the same encounter as the active I62 hemorrhage code, treating it simultaneously as both the acute event and the sequela. Per ICD-10-CM guideline Section I.C.9.d, sequela coding from I69 is not appropriate during the acute inpatient stay for the index hemorrhage — the I69 code is appropriate only when the neurological deficit is the reason for a subsequent encounter or is being captured as an additional condition after the acute phase has resolved.
Excludes 2
R27.0 — Ataxia, unspecified — R27.0 represents ataxia of unspecified or uncertain etiology, and when the causal cerebrovascular event is known and documented, I69.293 is the preferred code; both could theoretically coexist if a second, unrelated ataxia etiology (such as hereditary cerebellar ataxia) is also documented and independently present, though this would be rare and require explicit provider differentiation.
📋 Clinical Overview
Post-Hemorrhagic Ataxia vs. Related Cerebrovascular Sequelae
Distinguishing post-hemorrhagic ataxia from other I69 sequelae is important because the rehabilitation pathway, functional prognosis, and DRG impact differ significantly between manifestations such as hemiplegia, aphasia, and ataxia. Ataxia disproportionately affects posterior fossa structures and vestibulocerebellar pathways, while hemiplegia predominantly reflects corticospinal tract disruption. CDI teams should ensure provider documentation explicitly identifies the specific neurological deficit type rather than using vague language like “neurological deficits” to enable accurate code assignment and appropriate CC/MCC capture.
| Feature | I69.293 | I69.291 | I69.290 |
|---|---|---|---|
| Neurological Deficit | Ataxia — loss of voluntary coordination, gait instability, dysmetria | Dysphagia — impaired swallowing mechanism as a sequela of hemorrhage | Apraxia — inability to perform learned purposeful movements despite intact motor function |
| Causative Event | Other nontraumatic intracranial hemorrhage (I62 block, e.g., subdural) | Other nontraumatic intracranial hemorrhage (I62 block) | Other nontraumatic intracranial hemorrhage (I62 block) |
| Additional Code Required | None mandated; R26.2 should NOT be double-coded | Yes — R13.1- required to identify dysphagia type per guideline instruction | None mandated by tabular |
| Rehabilitation Impact | Affects gait, balance, fall risk — PT/OT referral typical | Affects nutrition, aspiration risk — SLP referral typical | Affects ADL performance — OT referral typical |
| CC/MCC Status | Verify per FY2026 MS-DRG definitions manual | Verify per FY2026 MS-DRG definitions manual | Verify per FY2026 MS-DRG definitions manual |
Important
This is a prime CDI trigger: when a patient is admitted post-ICH with “balance problems” or “unsteady gait,” the CDI specialist should query the attending or neurologist to confirm whether this represents ataxia as a sequela of the prior hemorrhage, and if so, link it explicitly to the causative I62 event. Vague symptom language will fall to a generic symptom code (R27.0) rather than the more specific and potentially HCC-relevant I69.293.
Manifestations & Symptom Burden
- Truncal ataxia — Instability of the torso during sitting or standing, often from vermis involvement; increases inpatient fall risk and may require 1:1 supervision documentation.
- Gait ataxia — Wide-based, unsteady, lurching gait pattern; commonly captured by PT assessments and should be reflected in physician documentation as ataxia rather than “gait abnormality” for precise coding.
- Limb dysmetria — Overshoot or undershoot during intentional limb movements (e.g., finger-nose testing); reflects cerebellar hemisphere involvement contralateral to the hemorrhagic lesion.
- Nystagmus — Involuntary rhythmic eye movements associated with vestibulo-cerebellar pathway disruption; if documented independently, may warrant additional coding with H55.0x.
- Dysdiadochokinesia — Impaired rapid alternating movements; typically documented on neurological exam and supports the ataxia diagnosis for coding purposes.
Tip
Per ICD-10-CM official guidelines, when a patient with a documented prior I62 hemorrhage presents with residual ataxia, the sequela (I69.293) is sequenced first, and any codes for the nature of the sequela or additional manifestations follow. Do not assign R27.0 in addition to I69.293 — R27.0 is reserved for ataxia of unknown etiology, and coding it alongside I69.293 would represent redundant coding of the same condition. Cross-reference the Official ICD-10-CM Guidelines Section I.C.9.d note for sequela sequencing rules.
💰 HCC Risk Adjustment
| HCC Model | Category | Label | RAF Impact |
|---|---|---|---|
| CMS-HCC v28 | Verify current mapping | Neurological deficit sequela — confirm annual crosswalk | Moderate |
| CMS-HCC v24 (legacy) | Verify current mapping | Sequelae of hemorrhagic stroke | Moderate |
ICD-10 CM I69.293 may carry risk-adjustment weight under CMS-HCC models when the ataxia represents a persistent, active, documented neurological deficit requiring ongoing care or intervention. Sequela codes within the I69 family are among the highest-value CDI targets for MA plans because they demonstrate ongoing disease burden from prior cerebrovascular events. Annual recapture is mandatory — these conditions must be coded at every encounter where they remain clinically active, not just once post-acute event. Coders working in MA risk adjustment should verify I69.293’s specific HCC mapping in the current CMS-HCC v28 crosswalk file published by CMS, as mapping can shift between model versions. The RAF value attached to cerebrovascular sequelae codes generally supports higher per-member-per-month payments when accurately and consistently captured across the plan year.
🏥 MS-DRG Assignment
| Condition | DRG | Description |
|---|---|---|
| With MCC | 064 | Intracranial Hemorrhage or Cerebral Infarction with MCC |
| With CC | 065 | Intracranial Hemorrhage or Cerebral Infarction with CC or tPA in 24 Hours |
| Without CC/MCC | 066 | Intracranial Hemorrhage or Cerebral Infarction without CC/MCC |
ICD-10 CM I69.293 groups into the DRG 064-066 triad under MDC 01 (Diseases and Disorders of the Nervous System), and the final DRG assignment hinges entirely on whether valid CCs or MCCs are documented and coded at the same encounter. Common MCCs in this population include aspiration pneumonia (J69.0), acute respiratory failure (J96.0x), and sepsis (A41.9), while common CCs include dysphagia (R13.10 — if not already captured via I69.291), malnutrition (E43/E44), and urinary tract infection (N39.0). Given that post-ICH ataxia patients are frequently high-acuity, failing to capture all documented comorbidities represents a significant revenue integrity risk. Sequencing of I69.293 as principal diagnosis is appropriate when the residual ataxia from the prior hemorrhage represents the main reason for the inpatient admission after the acute event has resolved.
🔗 Related ICD-10-CM Codes
Ataxia Sequelae by Causative Cerebrovascular Event
- I69.093 — Ataxia following nontraumatic subarachnoid hemorrhage
- I69.193 — Ataxia following nontraumatic intracerebral hemorrhage
- I69.393 — Ataxia following cerebral infarction
- I69.893 — Ataxia following other cerebrovascular disease
- I69.993 — Ataxia following unspecified cerebrovascular disease
Related Sequelae of Other Nontraumatic Intracranial Hemorrhage (I69.29x)
- I69.290 — Apraxia following other nontraumatic intracranial hemorrhage
- I69.291 — Dysphagia following other nontraumatic intracranial hemorrhage
- I69.292 — Facial weakness following other nontraumatic intracranial hemorrhage
- I69.298 — Other sequelae of other nontraumatic intracranial hemorrhage
- I62.00 — Nontraumatic subdural hemorrhage, unspecified (index event for I69.2x sequelae)
- R26.2 — Difficulty in walking, not elsewhere classified (supplement if separately documented and not already encompassed)
- Z86.73 — Personal history of cerebral infarction without residual effects (use when NO residual neurological deficit remains — mutually exclusive with I69 coding)
🛠️ Commonly Associated CPT Codes
- 99223 — Initial hospital care, high complexity — Commonly billed on admission for a patient presenting with post-hemorrhagic ataxia requiring detailed neurological evaluation and management planning; documentation must reflect high MDM or 75+ minutes of total time.
- 99233 — Subsequent hospital care, high complexity — Appropriate for daily rounding visits when the post-ICH ataxia patient has ongoing neurological instability or comorbidity management; MDM must reflect high complexity with multiple chronic/acute problems.
- 97110 — Therapeutic exercises — Physical therapy CPT frequently associated with inpatient rehabilitation for post-hemorrhagic ataxia; billed by PT providers to address gait retraining, balance, and coordination deficits resulting from the sequela.
- 97530 — Therapeutic activities — Occupational therapy code used when fine motor coordination and ADL performance are impaired by the ataxia; appropriate when functional task-based activities are the treatment modality.
- 92506 — Evaluation of speech, language, voice, communication, and/or auditory processing — Relevant when the hemorrhagic sequela also involves dysphagia or communication deficits concurrent with ataxia; billed by SLP providers.
- 99251-99255 — Inpatient consultation codes (where applicable by payer) — Neurology or PM&R consultations frequently generate these codes when a specialist is evaluating the extent of post-hemorrhagic neurological deficits including ataxia.
NCCI Bundling Considerations
Therapeutic procedure codes like 97110 and 97530 are subject to NCCI edits when billed together on the same date of service without a valid modifier indicating distinct services. E&M codes (99223, 99233) are not typically bundled with therapy CPT codes since they are billed by different provider types in the inpatient setting. Coders and billers should ensure that when multiple therapy disciplines (PT, OT, SLP) are involved in the care of an I69.293 patient, each discipline bills under their own NPI and the services are documented as distinctly medically necessary.
🔬 ICD-10-PCS Crosswalk
- F07Z9MZ — Motor Treatment, Neurological System and Cranial Nerves — This PCS code captures physical therapy-based motor treatment addressing the coordination and gait deficits resulting from the ataxia sequela; used in inpatient PCS coding when rehabilitation services are provided during the same stay.
- F06Z0MZ — Speech Treatment, Neurological System and Cranial Nerves — Applicable when SLP intervention targets oromotor sequelae concurrent with the ataxic presentation post-hemorrhage.
- B030YZZ — Fluoroscopy of Right Internal Carotid Artery — Not directly crosswalked but cerebrovascular imaging PCS codes (B30x series) may appear in the same encounter when vascular workup accompanies the sequela management; confirm with radiology documentation.
- 00J00ZZ — Inspection of Brain, Open — While not routinely performed in pure sequela management, cranial PCS inspection codes may be relevant if a surgical exploration or revision is undertaken in the context of evolving post-hemorrhagic complications.
💊 Coding Scenarios and Examples
Scenario 1 — Inpatient Rehab Admission for Post-Subdural Ataxia A 68-year-old male with a history of nontraumatic subdural hematoma (treated conservatively 6 weeks prior) is admitted to an inpatient rehabilitation unit for progressive gait ataxia, truncal instability, and inability to perform ADLs safely. The attending physician documents “cerebellar ataxia as sequela of prior subdural hematoma.” The patient also has hypertension (I10) and type 2 diabetes without complications (E11.9).
- Correct coding: I69.293, I10, E11.9
- Sequencing: I69.293 is the principal diagnosis as the ataxia sequela is the primary reason for admission; I10 and E11.9 are additional diagnoses.
- CDI note: Confirm physician explicitly documents causal link between the subdural hematoma history and current ataxia — without linkage, R27.0 would be the only supportable code, losing the specificity and potential HCC value of I69.293.
Scenario 2 — Inpatient Admission with Aspiration Pneumonia and Post-ICH Ataxia A 74-year-old female with a prior history of nontraumatic epidural hemorrhage (I62.1x, treated 3 months prior) is admitted with aspiration pneumonia and gait ataxia. The neurologist documents “persistent ataxia as late effect of prior intracranial hemorrhage” and the hospitalist confirms aspiration pneumonia due to impaired swallowing and coordination.
- Correct coding: J69.0 (principal — aspiration pneumonia as the reason for acute admission), I69.293, I69.291 (if dysphagia is also separately documented as a sequela)
- Sequencing: J69.0 is principal as it drove the acute hospitalization; I69.293 follows as a secondary diagnosis contributing to the clinical picture; DRG 064 likely with J69.0 as an MCC.
- CDI note: If dysphagia is also documented as a post-hemorrhagic sequela, both I69.291 and I69.293 may be coded — query provider to clarify whether dysphagia is independently present as a separate sequela or an extension of the ataxic deficit.
Scenario 3 — Outpatient Neurology Follow-Up (for reference) A 55-year-old male presents to neurology clinic for follow-up of residual cerebellar ataxia following a nontraumatic intracranial hemorrhage 4 months ago. He reports ongoing balance issues and uses a cane. No acute changes.
- Correct coding: I69.293, Z87.39 (personal history of other conditions of the nervous system, if applicable) — confirm personal history code applicability with payer
- Sequencing: I69.293 is the primary diagnosis for the outpatient encounter.
- CDI note: In an outpatient/profee setting, the ICD-10-CM guideline for sequela coding still applies — I69.293 is appropriate as long as the ataxia is the confirmed neurological residual of the prior hemorrhagic event.
⚠️ Coding Pitfalls and Tips
- Do not code I69.293 during the acute admission for the index I62 hemorrhage. Sequela codes from category I69 are never appropriate while the patient is still being treated for the causative acute hemorrhagic event; assign the active I62 code during the acute stay and transition to I69.293 only after the acute phase has resolved and a persistent deficit remains.
- Never double-code R27.0 alongside I69.293. R27.0 (Ataxia, unspecified) is for ataxia of undetermined or unspecified etiology; when the ataxia is definitively linked to a prior hemorrhagic event, I69.293 is complete and sufficient — adding R27.0 is redundant and incorrect per ICD-10-CM convention.
- Watch the 4th character carefully: I69.193 vs. I69.293. If the source bleed was intracerebral (I61), the correct ataxia sequela code is I69.193, not I69.293. If the source bleed was subdural, epidural, or other intracranial (I62), the correct code is I69.293. This is one of the most frequent specificity errors in stroke/hemorrhage sequela coding.
- Always capture associated comorbidities for DRG optimization. I69.293 by itself without CCs or MCCs will land in DRG 066 — a relatively low-weight assignment. Thorough capture of documented conditions like malnutrition, UTI, DVT, or respiratory compromise can shift the DRG to 065 or 064 and accurately reflect patient acuity.
- Use Z86.73 only when there are NO residual deficits. Personal history of cerebral infarction/hemorrhage without residual effects (Z86.73) is appropriate only when the patient has completely recovered; if any neurological deficit such as ataxia persists, I69.293 must be used instead — they are mutually exclusive in practice.
- Provider linkage is non-negotiable for I69 assignment. ICD-10-CM guidelines and UHDDS rules prohibit coders from independently inferring a causal relationship between a prior hemorrhage and a current neurological deficit without explicit provider documentation establishing the link. When documentation is ambiguous, a compliant CDI query is the correct pathway.