What is ICD-10 code I69.865?

I69.865 is the ICD-10-CM diagnosis code for Other paralytic syndrome following other cerebrovascular disease, bilateral. Weakness or loss of movement on both sides of the body resulting from a stroke or other brain blood vessel disease. I69.865 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. I69.865 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. I69.865 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. I69.865 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.

What is the V28 vs V24 difference for I69.865?

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 I69.865, V28 maps to Monoplegia, Other Paralytic Syndromes at RAF 0.000 while V24 mapped to Monoplegia, Other Paralytic Syndromes at RAF 0.304. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting I69.865?

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 Because I69.865 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

I69.865 ICD-10 Code: Other paralytic syndrome

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupI69.865Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

I69.865

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

Other paralytic syndrome following other cerebrovascular disease, bilateral

Weakness or loss of movement on both sides of the body resulting from a stroke or other brain blood vessel disease.

Buddy Insight

CMS-HCC V28

Mapped

HCC 254

Monoplegia, Other Paralytic S...

RAF 0.0

CMS-HCC V24

Mapped

HCC 104

Monoplegia, Other Paralytic S...

RAF 0.304

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Mapped

HCC 104

Monoplegia, Other Paralytic S...

RAF 0.0

RXHCC

Not risk-adjusted for this model/period.

RAF 0

Code Trumping

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Compare selected patient codes to show trumped or trumps impact.

Code Book Path

Official

I69.8Sequelae of other cerebrovascular diseases

I69.86Other paralytic syndrome following other cerebrovascular disease

I69.865Other paralytic syndrome following other cerebrovascular disease, bilateral

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for I69.865 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for I69.865 in this effective period.

Related Child Codes

Official

I69.861Other paralytic syndrome following other cerebrovascular disease affecting right dominant side

I69.862Other paralytic syndrome following other cerebrovascular disease affecting left dominant side

I69.863Other paralytic syndrome following other cerebrovascular disease affecting right non-dominant side

I69.864Other paralytic syndrome following other cerebrovascular disease affecting left non-dominant side

I69.869Other paralytic syndrome following other cerebrovascular disease affecting unspecified side

Includes

Official

ICD-10-CM does not list Includes notes for I69.865 in this effective period.

Excludes 1

Official

hemiplegia/hemiparesis following other cerebrovascular disease (I69.85-)
monoplegia of lower limb following other cerebrovascular disease (I69.84-)
monoplegia of upper limb following other cerebrovascular disease (I69.83-)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for I69.865 in this effective period.

Use Additional

Official

code to identify type of paralytic syndrome, such as:
locked-in state (G83.5)
quadriplegia (G82.5-)

Code Also

Official

ICD-10-CM does not list Code Also instructions for I69.865 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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

MEAT Support

HCC Buddy guidance

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

Audit Caution

HCC Buddy guidance

Defaulting to 'other paralytic syndrome' when the documentation actually describes hemiplegia or monoplegia — always verify the paralytic pattern before selecting this category

Coding an acute cerebrovascular event when the condition is actually a sequela — I69.x codes are exclusively for late effects, not the initial stroke episode

Using 'other cerebrovascular disease' sequela codes when the underlying cerebrovascular event is actually a cerebral infarction (I69.3x) or intracerebral hemorrhage (I69.1x) — always match the sequela code to the specific type of original cerebrovascular event

Failing to code the sequela relationship — these I69.x codes inherently indicate sequela status, so a separate external cause code with a 7th character 'S' for sequela is not required

Common Mistakes

HCC Buddy guidance

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

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is I69.865 an HCC code?

Yes. I69.865 maps to Monoplegia, Other Paralytic Syndromes under the CMS-HCC V28 risk adjustment model (and Monoplegia, Other Paralytic Syndromes under V24).

HCC Category Mapping

V28HCC 254, Monoplegia, Other Paralytic Syndromes

0.000

V24HCC 104, Monoplegia, Other Paralytic Syndromes

0.304

ESRDHCC 104, Monoplegia, Other Paralytic Syndromes

0.000

RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. 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.

MEAT Criteria for I69.865

For I69.865to 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 I69.865 during that encounter, not just copy-forwarded from a problem list.

What This Code Means

I69.865 is the ICD-10-CM diagnosis code for other paralytic syndrome following other cerebrovascular disease, bilateral. Weakness or loss of movement on both sides of the body resulting from a stroke or other brain blood vessel disease. I69.865 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, I69.865 maps to Monoplegia, Other Paralytic Syndromes (HCC 254) with a community, non-dual, aged base RAF weight of 0.000. Under the older V24 model, I69.865 mapped to the same category but with a base RAF weight of 0.304, 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.

This code specifically indicates bilateral (both sides) involvement; do not use if paralysis is unilateral. Because I69.865 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 I69.865 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