I69.865 ICD-10-CM Code: Other paralytic syndrome following other cerebrovascular disease, bilateral

Code

I69.865

Description

Other paralytic syndrome following other cerebrovascular disease, bilateral

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 I69.865 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for I69.865

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for I69.865 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •This code specifically indicates bilateral (both sides) involvement; do not use if paralysis is unilateral
• •Document the specific cerebrovascular event that caused the sequela to ensure accurate code selection

Clinical Significance

Other paralytic syndromes following other cerebrovascular disease capture residual motor deficits that do not fit the classic patterns of hemiplegia or monoplegia, such as locked-in syndrome, quadriplegia, or atypical paralytic presentations following cerebrovascular events. These conditions often require complex, multidisciplinary care including neurological monitoring, physical and occupational therapy, and specialized nursing services. Proper coding ensures these high-acuity, high-resource patients are appropriately reflected in risk adjustment calculations.

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
• ✓Description of the specific paralytic pattern (e.g., quadriplegia, locked-in syndrome, or other specified pattern) that distinguishes this from hemiplegia or monoplegia
• ✓Documentation confirming bilateral involvement of the paralytic syndrome
• ✓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

• •I69.96x: Other paralytic syndrome following unspecified cerebrovascular disease; use when the specific type of cerebrovascular disease is not documented
• •I69.85x: Hemiplegia/hemiparesis following other cerebrovascular disease; use when the paralysis follows a classic hemiplegic pattern affecting one entire side
• •I69.84x: Monoplegia of lower limb following other cerebrovascular disease; use when only a single limb is affected
• •G82.x: Paraplegia and quadriplegia not related to cerebrovascular disease; use for paralysis from spinal cord injury or other non-cerebrovascular causes
• •G83.9: Paralytic syndrome, unspecified; use only when the paralysis is not related to a cerebrovascular event

Child Codes