I63.423

Billable

Cerebral infarction due to embolism of bilateral anterior cerebral arteries

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

What This Code Means

A stroke caused by a blood clot that blocks both of the anterior cerebral arteries in the brain, cutting off blood flow to the front portions of both brain hemispheres. This is a serious condition that can result in significant neurological damage affecting movement, sensation, and cognitive function on both sides of the body.

Coding Tips

•Verify documentation specifies 'bilateral' involvement of anterior cerebral arteries; unilateral strokes use different codes (I63.41x for right, I63.42x for left)
•Ensure the etiology is documented as 'embolism' (blood clot traveling from elsewhere) rather than thrombosis (clot forming in place); this distinction is critical for accurate code selection

Clinical Significance

This code identifies an acute ischemic stroke caused by embolism (a clot originating from a distant source such as the heart or proximal vasculature) lodging in the bilateral anterior cerebral artery. The anterior cerebral artery supplies the medial surfaces of the frontal and parietal lobes, including the motor and sensory cortex for the lower extremity. Accurate coding of the mechanism, artery, and laterality is critical for risk adjustment and tracking stroke subtypes for quality measures and secondary prevention strategies.

Documentation Requirements

✓Provider documentation of acute cerebral infarction (stroke) as a confirmed diagnosis, not rule-out or suspected
✓Identification of the affected artery as the anterior cerebral artery
✓Documentation of laterality (bilateral) supported by clinical findings and/or imaging
✓Documentation that embolism is the underlying mechanism, with workup for embolic source (echocardiogram, cardiac monitoring for atrial fibrillation, carotid evaluation)
✓Neurological examination findings consistent with the identified vascular territory (e.g., contralateral leg weakness greater than arm weakness, personality changes, urinary incontinence, and abulia)
✓Brain imaging (computed tomography or magnetic resonance imaging) confirming acute infarction
✓Timing of symptom onset to confirm acute presentation
✓Documentation of stroke severity (National Institutes of Health Stroke Scale score preferred)
✓Treatment administered (thrombolytics, thrombectomy, antiplatelet therapy, anticoagulation)

Commonly Confused Codes

I63.323 — Cerebral infarction due to thrombosis of bilateral anterior cerebral arteries; use for thrombotic rather than embolic mechanism I69.3xx — Sequelae of cerebral infarction; use for residual deficits from a prior stroke during follow-up visits, not during the acute event G45.9 — Transient cerebral ischemic attack, unspecified; use when symptoms resolve completely within 24 hours with no evidence of infarction on imaging

Code Hierarchy

└I63Cerebral infarction └I63.4Cerebral infarction due to embolism of cerebral arteries └I63.42Cerebral infarction due to embolism of anterior cerebral artery └I63.423Cerebral infarction due to embolism of bilateral anterior cerebral arteries

└I63.423Cerebral infarction due to embolism of bilateral anterior cerebral arteries