What is ICD-10 code I69.359?

I69.359 is the ICD-10-CM diagnosis code for Hemiplegia and hemiparesis following cerebral infarction affecting unspecified side. Weakness or paralysis on one side of the body following a previous stroke, but the specific side is not documented or specified. I69.359 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. I69.359 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. I69.359 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. I69.359 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 I69.359 map to under V28?

I69.359 maps to CMS-HCC V28 253 (Hemiplegia/Hemiparesis). The category number and label come from the CMS-HCC V28 model file for payment year 2026.

What does I69.359 pay in RAF?

I69.359 carries a community, non-dual, aged (CNA) RAF weight of 0.387 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 I69.359?

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 I69.359, V28 maps to Hemiplegia/Hemiparesis at RAF 0.387 while V24 mapped to Hemiplegia/Hemiparesis at RAF 0.437. Both models can still appear in legacy data and in payer-specific lookback periods.

2026 ICD-10-CM I69.359: Hemiplegia and hemiparesis

I69.359 maps to CMS-HCC V28 253 (RAF 0.387). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC coding software

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Code lookupI69.359Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

I69.359

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

Hemiplegia and hemiparesis following cerebral infarction affecting unspecified side

Weakness or paralysis on one side of the body following a previous stroke, but the specific side is not documented or specified.

Buddy Insight

CMS-HCC V28

Mapped

HCC 253

Hemiplegia/Hemiparesis

RAF 0.387

CMS-HCC V24

Mapped

HCC 103

Hemiplegia/Hemiparesis

RAF 0.437

ACA/HHS

Mapped

HCC 150

HHS-HCC 150

Varies by metal level

ESRD/PACE

Mapped

HCC 103

Hemiplegia/Hemiparesis

RAF 0.071

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

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

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for I69.359 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for I69.359 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

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

Includes

Official

ICD-10-CM does not list Includes notes for I69.359 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for I69.359 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for I69.359 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for I69.359 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for I69.359 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

Defaulting to unspecified laterality without querying the provider — laterality and dominance should be documented whenever possible for specificity

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

Laterality-specific codes in the same subcategory — query provider for affected side and dominance before defaulting to unspecified

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 I69.359 an HCC code?

Yes. I69.359 (Hemiplegia and hemiparesis following cerebral infarction affecting unspecified side) maps to Hemiplegia/Hemiparesis under the CMS-HCC V28 risk adjustment model (and Hemiplegia/Hemiparesis under V24), with a community non-dual aged RAF of 0.387. It is billable for payment year 2026.

Coder answer: I69.359 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: I69.359
Description: Hemiplegia and hemiparesis following cerebral infarction affecting unspecified side
HCC (V28): HCC 253 — Hemiplegia/Hemiparesis
RAF: 0.387
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 253, Hemiplegia/Hemiparesis

0.387

V24HCC 103, Hemiplegia/Hemiparesis

0.437

ESRDHCC 103, Hemiplegia/Hemiparesis

0.071

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 I69.359 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for I69.359

For I69.359 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 I69.359 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

I69.359 is the ICD-10-CM diagnosis code for hemiplegia and hemiparesis following cerebral infarction affecting unspecified side. Weakness or paralysis on one side of the body following a previous stroke, but the specific side is not documented or specified. I69.359 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, I69.359 maps to Hemiplegia/Hemiparesis (HCC 253) with a community, non-dual, aged base RAF weight of 0.387. Under the older V24 model, I69.359 mapped to the same category but with a base RAF weight of 0.437, 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.

Use this code only when the affected side cannot be determined from medical record documentation. Because I69.359 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 I69.359 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Use this code only when the affected side cannot be determined from medical record documentation
•Query the provider if laterality information is available but not clearly documented

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)
✓Affected side should be specified when possible; query the provider if laterality is not documented
✓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
•Laterality-specific codes in the same subcategory: query provider for affected side and dominance before defaulting to unspecified