I69.854 ICD-10-CM Code: Hemiplegia and hemiparesis following other cerebrovascular disease affecting left non-dominant side

Code

I69.854

Description

Hemiplegia and hemiparesis following other cerebrovascular disease affecting left non-dominant side

HCC (V28)

HCC 253 — Hemiplegia/Hemiparesis

RAF reference coefficient

0.387

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 I69.854 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for I69.854

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for I69.854 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •This code applies to right-handed individuals with left-sided hemiplegia/hemiparesis
• •Confirm documentation specifies both upper and lower limb involvement on the left side

Clinical Significance

Hemiplegia and hemiparesis following other cerebrovascular disease represents one of the most functionally devastating sequelae of stroke, affecting an entire side of the body and profoundly limiting mobility, self-care, and independence. This condition carries higher resource utilization than monoplegia due to the greater scope of neurological impairment and the need for intensive rehabilitation, durable medical equipment, and caregiver support. Accurate coding is critical for risk adjustment as hemiplegia maps to a higher-weighted HCC than monoplegia, reflecting its greater clinical severity.

Documentation Requirements

• ✓Documentation of the specific type of prior cerebrovascular event (stroke, hemorrhage, or other cerebrovascular disease) that caused the sequela
• ✓Clear statement establishing a causal relationship between the prior cerebrovascular event and the current neurological deficit
• ✓Documentation that the condition is a late effect or sequela, not an acute or evolving stroke
• ✓Documentation specifying whether the deficit is complete paralysis (hemiplegia) or partial weakness (hemiparesis)
• ✓Documentation of the affected side (right or left) AND whether it is the patient's dominant or non-dominant side
• ✓Current functional status assessment including impact on activities of daily living, mobility, and need for assistive devices or caregiver support
• ✓Ongoing treatment plan addressing the neurological deficit (physical therapy, occupational therapy, medications, or other interventions)

Commonly Confused Codes

• •I69.95x: Hemiplegia/hemiparesis following unspecified cerebrovascular disease; use when the specific type of cerebrovascular disease is not documented
• •I69.84x: Monoplegia of lower limb following other cerebrovascular disease; use when only one limb is paralyzed, not the entire side
• •I69.83x: Monoplegia of upper limb following other cerebrovascular disease; use when only one arm is paralyzed, not the entire side
• •G81.x: Hemiplegia unspecified as to cause; use when the hemiplegia is not documented as a sequela of cerebrovascular disease
• •I63.x: Cerebral infarction (acute stroke); use for the initial acute event, not for long-term sequelae

Child Codes