I69.333 ICD-10-CM Code: Monoplegia of upper limb following cerebral infarction affecting right non-dominant side

Code

I69.333

Description

Monoplegia of upper limb following cerebral infarction affecting right non-dominant side

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 I69.333 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for I69.333

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for I69.333 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •This represents right non-dominant side involvement; ensure dominance is clearly documented
• •Non-dominant side monoplegia may have different functional implications than dominant side involvement

Clinical Significance

Monoplegia of the upper limb as a sequela of a cerebral infarction (ischemic stroke) represents a chronic neurological deficit that significantly impacts the patient's functional status and ongoing care needs. Upper limb monoplegia affects the patient's ability to perform fine motor tasks, self-care activities, and may require occupational therapy and adaptive equipment. Accurate capture of this sequela is important for risk adjustment as it reflects ongoing neurological impairment requiring continued medical management and rehabilitation services.

Documentation Requirements

• ✓Documentation of prior cerebral infarction (stroke) 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
• ✓Documentation that paralysis or weakness is isolated to one upper extremity (arm)
• ✓Current functional status of the affected upper limb including strength assessment
• ✓Documentation of which side is affected (right or left)
• ✓Documentation of patient's hand dominance to determine dominant vs non-dominant classification
• ✓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/I69.2/I69.8xx codes: sequelae of different cerebrovascular event types; must match the documented causative event
• •G83.2x (Monoplegia of upper limb, not specified as sequela): use G83.2 when cause is not cerebrovascular
• •I69.x5x (Hemiplegia): if both upper and lower limbs on same side are affected, code hemiplegia instead
• •Dominant vs non-dominant side codes: verify patient handedness; right-handed patients have right dominant side, left-handed have right non-dominant

Child Codes