What is ICD-10 code I69.354?

I69.354 is the ICD-10-CM diagnosis code for Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side. It belongs to the ICD-10-CM chapter for diseases of the circulatory system (i00-i99). I69.354 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. I69.354 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. I69.354 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. I69.354 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 I69.354 map to under V28?

I69.354 maps to CMS-HCC V28 HCC 253 (Hemiplegia/Hemiparesis). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

What documentation supports I69.354?

Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side, sequela with left-sided weakness in a right-dominant patient. Laterality and dominance both matter, the I69.35x codes differentiate on both axes. Documentation should make both explicit. V28 HCC 253 at RAF 0.387. Because I69.354 maps to an HCC category, the documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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 I69.354: Hemiplegia and hemiparesis

I69.354 maps to CMS-HCC V28 253. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · free HCC coding tools

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Code lookupI69.354Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

I69.354

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

Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side

This code describes weakness or paralysis on the left side of the body that resulted from a previous stroke (cerebral infarction), where the left side is the non-dominant side (opposite the person's dominant hand). The patient has residual effects from the stroke affecting their motor function on that side.

Buddy Insight

CMS-HCC V28

Mapped

HCC 253

Hemiplegia/Hemiparesis

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 150

HHS-HCC 150 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 103

Hemiplegia/Hemiparesis

Code-level coefficient reference

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

I69.3Sequelae of cerebral infarction

I69.35Hemiplegia and hemiparesis following cerebral infarction

I69.354Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for I69.354 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for I69.354 in this effective period.

Related Child Codes

Official

I69.351Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side

I69.352Hemiplegia and hemiparesis following cerebral infarction affecting left dominant side

I69.353Hemiplegia and hemiparesis following cerebral infarction affecting right non-dominant side

I69.359Hemiplegia and hemiparesis following cerebral infarction affecting unspecified side

Includes

Official

ICD-10-CM does not list Includes notes for I69.354 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for I69.354 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for I69.354 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for I69.354 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for I69.354 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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

Description of hemiplegia or hemiparesis affecting one entire side of the body (both upper and lower extremities)

Current functional status and severity of the hemiplegia/hemiparesis (complete vs incomplete paralysis)

MEAT Support

HCC Buddy guidance

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

Description of hemiplegia or hemiparesis affecting one entire side of the body (both upper and lower extremities)

Current functional status and severity of the hemiplegia/hemiparesis (complete vs incomplete paralysis)

Audit Caution

HCC Buddy guidance

Using an acute cerebrovascular code (I60-I63) instead of a sequela code (I69) when the event occurred in a prior encounter

Coding monoplegia when both upper and lower limbs on the same side are affected — this should be coded as hemiplegia

Confusing hemiplegia (paralysis) with hemisensory loss or hemineglect, which require different codes

Incorrectly assigning dominant vs non-dominant side — if handedness is not documented, the default assumption is right-hand dominance per ICD-10-CM guidelines

Common Mistakes

HCC Buddy guidance

I69.1/I69.2/I69.8xx codes — sequelae of different cerebrovascular event types; must match the documented causative event

G81.x (Hemiplegia and hemiparesis, not specified as sequela) — use G81 when not a sequela of cerebrovascular disease

I69.x5x vs I69.x4x (Monoplegia of lower limb) — hemiplegia affects an entire side, not just one limb

Dominant vs non-dominant side codes — verify patient handedness; left-handed patients have left dominant side, right-handed have left non-dominant

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 I69.354 an HCC code?

Yes. I69.354 (Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side) maps to HCC 253, Hemiplegia/Hemiparesis under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.387. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: I69.354 is billable and maps to V28 HCC 253, Hemiplegia/Hemiparesis. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: I69.354
Description: Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side
HCC (V28): HCC 253 — Hemiplegia/Hemiparesis
RAF reference coefficient: 0.387
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 253, Hemiplegia/Hemiparesis

0.387

ESRDHCC 103, Hemiplegia/Hemiparesis

Not separately weighted

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 I69.354 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for I69.354

For I69.354 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 I69.354 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

I69.354 is the ICD-10-CM diagnosis code for hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side. This code describes weakness or paralysis on the left side of the body that resulted from a previous stroke (cerebral infarction), where the left side is the non-dominant side (opposite the person's dominant hand). The patient has residual effects from the stroke affecting their motor function on that side. I69.354 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, I69.354 maps to Hemiplegia/Hemiparesis (HCC 253) with a source-labeled community, non-dual, aged reference coefficient of 0.387. No V24 mapping is shown for I69.354; use the applicable model and payment year when reviewing the V28 mapping. 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. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side, sequela with left-sided weakness in a right-dominant patient. Because I69.354 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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, source-labeled coefficient references, and MEAT documentation criteria for I69.354 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Hemiplegia and hemiparesis following cerebral infarction affecting left non-dominant side, sequela with left-sided weakness in a right-dominant patient.
•Laterality and dominance both matter, the I69.35x codes differentiate on both axes. Documentation should make both explicit.

Clinical Significance

Hemiplegia and hemiparesis 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. Hemiplegia involves paralysis or significant weakness affecting one entire side of the body, requiring ongoing rehabilitation, fall prevention strategies, and often assistive devices for activities of daily living. This condition is a key risk adjustment indicator as it reflects severe neurological damage with high resource utilization for therapy, home health, and durable medical equipment.

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
✓Description of hemiplegia or hemiparesis affecting one entire side of the body (both upper and lower extremities)
✓Current functional status and severity of the hemiplegia/hemiparesis (complete vs incomplete paralysis)
✓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
•G81.x (Hemiplegia and hemiparesis, not specified as sequela): use G81 when not a sequela of cerebrovascular disease
•I69.x5x vs I69.x4x (Monoplegia of lower limb): hemiplegia affects an entire side, not just one limb
•Dominant vs non-dominant side codes: verify patient handedness; left-handed patients have left dominant side, right-handed have left non-dominant