What is ICD-10 code I63.119?

I63.119 is the ICD-10-CM diagnosis code for Cerebral infarction due to embolism of unspecified vertebral artery. A stroke caused by a blood clot blocking a vertebral artery, but it is unclear whether it is the right or left side. I63.119 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. I63.119 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. I63.119 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. I63.119 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for I63.119?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For I63.119, V28 maps to Ischemic or Unspecified Stroke at RAF 0.289 while V24 mapped to Ischemic or Unspecified Stroke at RAF 0.262. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting I63.119?

Use this code only when laterality cannot be determined from documentation; query the provider if possible for clarification. This is a less specific code; attempt to obtain laterality information to assign a more precise code. Because I63.119 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

I63.119 ICD-10 Code: Cerebral infarction due

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupI63.119Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the circulatory system (I00-I99) / Cerebrovascular diseases (I60-I69)

I63.119

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Cerebral infarction due to embolism of unspecified vertebral artery

A stroke caused by a blood clot blocking a vertebral artery, but it is unclear whether it is the right or left side.

Buddy Insight

CMS-HCC V28

Mapped

HCC 249

Ischemic or Unspecified Stroke

RAF 0.289

CMS-HCC V24

Mapped

HCC 100

Ischemic or Unspecified Stroke

RAF 0.262

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Mapped

HCC 100

Ischemic or Unspecified Stroke

RAF 0.0

RXHCC

Not risk-adjusted for this model/period.

RAF 0

Code Trumping

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Code Book Path

Official

I63.1Cerebral infarction due to embolism of precerebral arteries

I63.11Cerebral infarction due to embolism of vertebral artery

I63.119Cerebral infarction due to embolism of unspecified vertebral artery

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for I63.119 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for I63.119 in this effective period.

Related Child Codes

Official

I63.111Cerebral infarction due to embolism of right vertebral artery

I63.112Cerebral infarction due to embolism of left vertebral artery

I63.113Cerebral infarction due to embolism of bilateral vertebral arteries

Includes

Official

ICD-10-CM does not list Includes notes for I63.119 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for I63.119 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for I63.119 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for I63.119 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for I63.119 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Imaging confirmation of posterior circulation cerebral infarction

Documentation of vertebral artery embolism as the mechanism

Documentation explaining why laterality could not be determined

Neurological examination with posterior circulation findings

MEAT Support

HCC Buddy guidance

Imaging confirmation of posterior circulation cerebral infarction

Documentation of vertebral artery embolism as the mechanism

Documentation explaining why laterality could not be determined

Neurological examination with posterior circulation findings

Audit Caution

HCC Buddy guidance

Defaulting to unspecified laterality without reviewing vascular imaging

Not querying the provider for laterality information

Confusing embolism mechanism with thrombosis

Using this code when the vertebral artery is not the actual site of occlusion

Common Mistakes

HCC Buddy guidance

I63.111 — Embolism of right vertebral artery; use when right side documented

I63.112 — Embolism of left vertebral artery; use when left side documented

I63.113 — Embolism of bilateral vertebral arteries; use when both sides involved

I63.019 — Thrombosis of unspecified vertebral artery; different mechanism

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is I63.119 an HCC code?

Yes. I63.119 maps to Ischemic or Unspecified Stroke under the CMS-HCC V28 risk adjustment model (and Ischemic or Unspecified Stroke under V24).

HCC Category Mapping

V28HCC 249, Ischemic or Unspecified Stroke

0.289

V24HCC 100, Ischemic or Unspecified Stroke

0.262

ESRDHCC 100, Ischemic or Unspecified Stroke

0.000

RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

MEAT Criteria for I63.119

For I63.119to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed I63.119 during that encounter, not just copy-forwarded from a problem list.

What This Code Means

I63.119 is the ICD-10-CM diagnosis code for cerebral infarction due to embolism of unspecified vertebral artery. A stroke caused by a blood clot blocking a vertebral artery, but it is unclear whether it is the right or left side. I63.119 sits in the ICD-10-CM chapter for diseases of the circulatory system (i00-i99), within the section covering cerebrovascular diseases (i60-i69).

Under the CMS-HCC V28 risk adjustment model, I63.119 maps to Ischemic or Unspecified Stroke (HCC 249) with a community, non-dual, aged base RAF weight of 0.289. Under the older V24 model, I63.119 mapped to the same category but with a base RAF weight of 0.262, V28 recalibrated weights across the entire model. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.

Use this code only when laterality cannot be determined from documentation; query the provider if possible for clarification. Because I63.119 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for I63.119 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Use this code only when laterality cannot be determined from documentation; query the provider if possible for clarification.
•This is a less specific code; attempt to obtain laterality information to assign a more precise code.

Clinical Significance

Cerebral infarction due to embolism of an unspecified vertebral artery captures posterior circulation embolic strokes where the vertebral artery is identified as the site of occlusion but the laterality is unknown. This represents a documentation specificity gap since vascular imaging typically identifies the affected side. The code still captures the full stroke HCC weight for risk adjustment.

Documentation Requirements

✓Imaging confirmation of posterior circulation cerebral infarction
✓Documentation of vertebral artery embolism as the mechanism
✓Documentation explaining why laterality could not be determined
✓Neurological examination with posterior circulation findings
✓Embolic source evaluation
✓Treatment and prevention plan

Commonly Confused Codes

•I63.111: Embolism of right vertebral artery; use when right side documented
•I63.112: Embolism of left vertebral artery; use when left side documented
•I63.113: Embolism of bilateral vertebral arteries; use when both sides involved
•I63.019: Thrombosis of unspecified vertebral artery; different mechanism
•I63.10: Embolism of unspecified precerebral artery; does not identify the artery