I69.369

HCC Category Mapping

What This Code Means

Partial or complete loss of muscle function following a previous stroke, but the specific side or pattern is not documented or specified.

Coding Tips

• •Use only when laterality cannot be determined from available documentation
• •Query provider for clarification on affected side(s) when possible to assign more specific code

Clinical Significance

Other paralytic syndrome 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. 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 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
• ✓Specific description of the paralytic syndrome that does not fit monoplegia or hemiplegia categories
• ✓Current functional status and extent of paralytic involvement
• ✓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