What is ICD-10 code I69.065?

I69.065 is the ICD-10-CM diagnosis code for Other paralytic syndrome following nontraumatic subarachnoid hemorrhage, bilateral. Weakness or paralysis affecting both sides of the body that developed as a complication after a spontaneous brain bleed in the space around the brain. I69.065 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. I69.065 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. I69.065 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. I69.065 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.

Which HCC does I69.065 map to under V28?

I69.065 maps to CMS-HCC V28 254 (Monoplegia, Other Paralytic Syndromes). The category number and label come from the CMS-HCC V28 model file for payment year 2026.

What does I69.065 pay in RAF?

I69.065 carries a community, non-dual, aged (CNA) RAF weight of 0.321 under CMS-HCC V28 for payment year 2026. The weight comes from the CMS V28 relative-factor file, not a hand-typed table.

What is the V28 vs V24 difference for I69.065?

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 I69.065, V28 maps to Monoplegia, Other Paralytic Syndromes at RAF 0.321 while V24 mapped to Monoplegia, Other Paralytic Syndromes at RAF 0.331. Both models can still appear in legacy data and in payer-specific lookback periods.

What documentation supports I69.065?

Document that paralysis is bilateral and is a sequela of nontraumatic subarachnoid hemorrhage Bilateral coding indicates involvement of both right and left sides; do not use with unilateral codes Because I69.065 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. See the MEAT criteria checklist at /meat-criteria for what Monitor, Evaluate, Assess, or Treat looks like in a note. MEAT is generic documentation evidence, not a payer-specific rule.

2026 ICD-10-CM I69.065: Other paralytic syndrome

I69.065 maps to CMS-HCC V28 254 (RAF 0.321). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC coding software

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Code lookupI69.065Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

I69.065

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

Other paralytic syndrome following nontraumatic subarachnoid hemorrhage, bilateral

Weakness or paralysis affecting both sides of the body that developed as a complication after a spontaneous brain bleed in the space around the brain.

Buddy Insight

This code captures other paralytic syndrome (bilateral) as a late effect of prior nontraumatic subarachnoid hemorrhage.

CMS-HCC V28

Mapped

HCC 254

Monoplegia, Other Paralytic S...

RAF 0.321

CMS-HCC V24

Mapped

HCC 104

Monoplegia, Other Paralytic S...

RAF 0.331

ACA/HHS

Mapped

HCC 151

HHS-HCC 151

Varies by metal level

ESRD/PACE

Mapped

HCC 104

Monoplegia, Other Paralytic S...

RAF 0.047

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

I69.0Sequelae of nontraumatic subarachnoid hemorrhage

I69.06Other paralytic syndrome following nontraumatic subarachnoid hemorrhage

I69.065Other paralytic syndrome following nontraumatic subarachnoid hemorrhage, bilateral

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for I69.065 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for I69.065 in this effective period.

Related Child Codes

Official

I69.061Other paralytic syndrome following nontraumatic subarachnoid hemorrhage affecting right dominant side

I69.062Other paralytic syndrome following nontraumatic subarachnoid hemorrhage affecting left dominant side

I69.063Other paralytic syndrome following nontraumatic subarachnoid hemorrhage affecting right non-dominant side

I69.064Other paralytic syndrome following nontraumatic subarachnoid hemorrhage affecting left non-dominant side

I69.069Other paralytic syndrome following nontraumatic subarachnoid hemorrhage affecting unspecified side

Includes

Official

ICD-10-CM does not list Includes notes for I69.065 in this effective period.

Excludes 1

Official

hemiplegia/hemiparesis following nontraumatic subarachnoid hemorrhage (I69.05-)
monoplegia of lower limb following nontraumatic subarachnoid hemorrhage (I69.04-)
monoplegia of upper limb following nontraumatic subarachnoid hemorrhage (I69.03-)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for I69.065 in this effective period.

Use Additional

Official

code to identify type of paralytic syndrome, such as:
locked-in state (G83.5)
quadriplegia (G82.5-)

Code Also

Official

ICD-10-CM does not list Code Also instructions for I69.065 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Clear documentation of other paralytic syndrome as a current, active condition (not just historical)

Documentation linking the paralytic deficit to a prior nontraumatic subarachnoid hemorrhage

Specification of affected side and dominance (right dominant, left dominant, right non-dominant, left non-dominant)

Current functional status assessment and impact on activities of daily living

MEAT Support

HCC Buddy guidance

Clear documentation of other paralytic syndrome as a current, active condition (not just historical)

Documentation linking the paralytic deficit to a prior nontraumatic subarachnoid hemorrhage

Specification of affected side and dominance (right dominant, left dominant, right non-dominant, left non-dominant)

Current functional status assessment and impact on activities of daily living

Audit Caution

HCC Buddy guidance

Coding an acute stroke code (I60.x) instead of the sequela code (I69.0x) — sequelae codes are for residual deficits from a prior event, not the acute stroke itself

Failing to specify laterality and dominance — the 5th and 6th characters indicate affected side and whether it is the dominant or non-dominant side

Confusing subarachnoid hemorrhage sequelae (I69.0x) with intracerebral hemorrhage sequelae (I69.1x) — different underlying stroke types

Not recapturing the sequela code annually — these are chronic conditions that should be reported each year the deficit persists

Common Mistakes

HCC Buddy guidance

I69.03x — Monoplegia of upper limb following nontraumatic subarachnoid hemorrhage; use for single upper limb paralysis

I69.04x — Monoplegia of lower limb following nontraumatic subarachnoid hemorrhage; use for single lower limb paralysis

I69.05x — Hemiplegia/hemiparesis following nontraumatic subarachnoid hemorrhage; use for one-sided paralysis

I69.16x — Other paralytic syndrome following nontraumatic intracerebral hemorrhage; different type of hemorrhagic stroke

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is I69.065 an HCC code?

Yes. I69.065 (Other paralytic syndrome following nontraumatic subarachnoid hemorrhage, bilateral) maps to Monoplegia, Other Paralytic Syndromes under the CMS-HCC V28 risk adjustment model (and Monoplegia, Other Paralytic Syndromes under V24), with a community non-dual aged RAF of 0.321. It is billable for payment year 2026.

Coder answer: I69.065 is billable and maps to V28 HCC 254, Monoplegia, Other Paralytic Syndromes. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: I69.065
Description: Other paralytic syndrome following nontraumatic subarachnoid hemorrhage, bilateral
HCC (V28): HCC 254 — Monoplegia, Other Paralytic Syndromes
RAF: 0.321
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 254, Monoplegia, Other Paralytic Syndromes

0.321

V24HCC 104, Monoplegia, Other Paralytic Syndromes

0.331

ESRDHCC 104, Monoplegia, Other Paralytic Syndromes

0.047

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. 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.

Work I69.065 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for I69.065

For I69.065 to 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 I69.065 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

I69.065 is the ICD-10-CM diagnosis code for other paralytic syndrome following nontraumatic subarachnoid hemorrhage, bilateral. Weakness or paralysis affecting both sides of the body that developed as a complication after a spontaneous brain bleed in the space around the brain. I69.065 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, I69.065 maps to Monoplegia, Other Paralytic Syndromes (HCC 254) with a community, non-dual, aged base RAF weight of 0.321. Under the older V24 model, I69.065 mapped to the same category but with a base RAF weight of 0.331, 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.

Document that paralysis is bilateral and is a sequela of nontraumatic subarachnoid hemorrhage. Because I69.065 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 I69.065 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document that paralysis is bilateral and is a sequela of nontraumatic subarachnoid hemorrhage
•Bilateral coding indicates involvement of both right and left sides; do not use with unilateral codes

Clinical Significance

This code captures other paralytic syndrome (bilateral) as a late effect of prior nontraumatic subarachnoid hemorrhage. Other paralytic syndromes include quadriplegia, locked-in syndrome, or atypical paralytic patterns that do not fit monoplegia or hemiplegia classifications. These conditions represent significant neurological sequelae requiring ongoing management and substantially impact risk adjustment scoring.

Documentation Requirements

✓Clear documentation of other paralytic syndrome as a current, active condition (not just historical)
✓Documentation linking the paralytic deficit to a prior nontraumatic subarachnoid hemorrhage
✓Specification of affected side and dominance (right dominant, left dominant, right non-dominant, left non-dominant)
✓Current functional status assessment and impact on activities of daily living
✓Ongoing treatment plan (physical therapy, occupational therapy, medications for spasticity)
✓Documentation that the original stroke was a subarachnoid hemorrhage specifically (not intracerebral hemorrhage or cerebral infarction)

Commonly Confused Codes

•I69.03x: Monoplegia of upper limb following nontraumatic subarachnoid hemorrhage; use for single upper limb paralysis
•I69.04x: Monoplegia of lower limb following nontraumatic subarachnoid hemorrhage; use for single lower limb paralysis
•I69.05x: Hemiplegia/hemiparesis following nontraumatic subarachnoid hemorrhage; use for one-sided paralysis
•I69.16x: Other paralytic syndrome following nontraumatic intracerebral hemorrhage; different type of hemorrhagic stroke
•G83.9: Paralytic syndrome, unspecified; use when cause is not stroke sequela