I69.265 ICD-10-CM Code: Other paralytic syndrome following other nontraumatic intracranial hemorrhage, bilateral

Code

I69.265

Description

Other paralytic syndrome following other nontraumatic intracranial hemorrhage, bilateral

HCC (V28)

HCC 254 — Monoplegia, Other Paralytic Syndromes

RAF reference coefficient

0.321

Billable

Yes

Payment year

2026

HCC Category Mapping

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work I69.265 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for I69.265

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for I69.265 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •Use this code when paralysis is documented on both the right and left sides
• •Bilateral presentation may indicate more severe brain involvement; ensure documentation supports this finding

Clinical Significance

Other paralytic syndrome as a sequela of a nontraumatic intracranial hemorrhage other than intracerebral (such as subarachnoid or subdural hemorrhage) represents a chronic neurological deficit that significantly impacts the patient's functional status and ongoing care needs. This category captures paralytic syndromes that do not fit the specific monoplegia or hemiplegia patterns, such as locked-in syndrome, quadriplegia following stroke, or other complex motor deficits. These conditions represent significant risk adjustment value as they indicate severe neurological compromise with substantial ongoing care requirements.

Documentation Requirements

• ✓Documentation of prior other nontraumatic intracranial hemorrhage as the causative event with clear causal linkage to the current deficit
• ✓Confirmation that this is a sequela (late effect), not an acute or current cerebrovascular event
• ✓Specific description of the paralytic syndrome that does not fit monoplegia or hemiplegia categories
• ✓Current functional status and extent of paralytic involvement
• ✓Documentation of bilateral involvement with specific description of deficits on both sides
• ✓Current treatment plan including rehabilitation services, medications, and adaptive equipment
• ✓Assessment that the condition is being actively monitored or managed during the encounter

Commonly Confused Codes

• •I69.1/I69.3/I69.8xx codes: sequelae of different cerebrovascular event types; must match the documented causative event
• •G83.9 (Paralytic syndrome, unspecified): use when not a sequela of cerebrovascular disease
• •I69.x5x (Hemiplegia/hemiparesis): use when paralysis specifically fits the hemiplegia pattern affecting one side
• •Unilateral codes in the same subcategory: bilateral involvement must be clearly documented; do not assume bilateral from vague descriptions

Child Codes