What is ICD-10 code I69.965?

I69.965 is the ICD-10-CM diagnosis code for Other paralytic syndrome following unspecified cerebrovascular disease, bilateral. Weakness or paralysis affecting both sides of the body in a symmetrical or asymmetrical pattern following a stroke. It belongs to the ICD-10-CM chapter for diseases of the circulatory system (i00-i99). I69.965 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. I69.965 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. I69.965 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. I69.965 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 I69.965 map to under V28?

I69.965 maps to CMS-HCC V28 254 (Monoplegia, Other Paralytic Syndromes). The category number and label come from the CMS-HCC V28 model file for payment year 2026.

What does I69.965 pay in RAF?

I69.965 carries a community, non-dual, aged (CNA) RAF weight of 0.321 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 I69.965?

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 I69.965, V28 maps to Monoplegia, Other Paralytic Syndromes at RAF 0.321 while V24 mapped to Monoplegia, Other Paralytic Syndromes at RAF 0.331. Both models can still appear in legacy data and in payer-specific lookback periods.

What documentation supports I69.965?

Bilateral designation indicates involvement of both right and left sides; document whether the weakness is symmetrical or asymmetrical This code is used for complex paralytic syndromes affecting multiple limbs on both sides of the body Because I69.965 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. See the MEAT criteria checklist at /meat-criteria for what Monitor, Evaluate, Assess, or Treat looks like in a note. MEAT is generic documentation evidence, not a payer-specific rule.

2026 ICD-10-CM I69.965: Other paralytic

I69.965 maps to CMS-HCC V28 254 (RAF 0.321). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC coding software

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Code lookupI69.965Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

I69.965

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

Other paralytic syndrome following unspecified cerebrovascular disease, bilateral

Weakness or paralysis affecting both sides of the body in a symmetrical or asymmetrical pattern following a stroke.

Buddy Insight

CMS-HCC V28

Mapped

HCC 254

Monoplegia, Other Paralytic S...

RAF 0.321

CMS-HCC V24

Mapped

HCC 104

Monoplegia, Other Paralytic S...

RAF 0.331

ACA/HHS

Mapped

HCC 151

HHS-HCC 151

Varies by metal level

ESRD/PACE

Mapped

HCC 104

Monoplegia, Other Paralytic S...

RAF 0.047

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

I69.9Sequelae of unspecified cerebrovascular diseases

I69.96Other paralytic syndrome following unspecified cerebrovascular disease

I69.965Other paralytic syndrome following unspecified cerebrovascular disease, bilateral

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for I69.965 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for I69.965 in this effective period.

Related Child Codes

Official

I69.961Other paralytic syndrome following unspecified cerebrovascular disease affecting right dominant side

I69.962Other paralytic syndrome following unspecified cerebrovascular disease affecting left dominant side

I69.963Other paralytic syndrome following unspecified cerebrovascular disease affecting right non-dominant side

I69.964Other paralytic syndrome following unspecified cerebrovascular disease affecting left non-dominant side

I69.969Other paralytic syndrome following unspecified cerebrovascular disease affecting unspecified side

Includes

Official

ICD-10-CM does not list Includes notes for I69.965 in this effective period.

Excludes 1

Official

hemiplegia/hemiparesis following unspecified cerebrovascular disease (I69.95-)
monoplegia of lower limb following unspecified cerebrovascular disease (I69.94-)
monoplegia of upper limb following unspecified cerebrovascular disease (I69.93-)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for I69.965 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 I69.965 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 the unspecified cerebrovascular disease sequela code when the medical record contains documentation of the specific type of cerebrovascular event — always query the provider or review historical records for the original diagnosis

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

I69.86x — Other paralytic syndrome following other cerebrovascular disease; use when the specific type of cerebrovascular disease is documented

I69.95x — Hemiplegia/hemiparesis following unspecified cerebrovascular disease; use when the paralysis follows a classic hemiplegic pattern

I69.94x — Monoplegia of lower limb following unspecified 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

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 I69.965 an HCC code?

Yes. I69.965 (Other paralytic syndrome following unspecified cerebrovascular disease, bilateral) maps to Monoplegia, Other Paralytic Syndromes under the CMS-HCC V28 risk adjustment model (and Monoplegia, Other Paralytic Syndromes under V24), with a community non-dual aged RAF of 0.321. It is billable for payment year 2026.

Coder answer: I69.965 is billable and maps to V28 HCC 254, Monoplegia, Other Paralytic Syndromes. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: I69.965
Description: Other paralytic syndrome following unspecified cerebrovascular disease, bilateral
HCC (V28): HCC 254 — Monoplegia, Other Paralytic Syndromes
RAF: 0.321
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 254, Monoplegia, Other Paralytic Syndromes

0.321

V24HCC 104, Monoplegia, Other Paralytic Syndromes

0.331

ESRDHCC 104, Monoplegia, Other Paralytic Syndromes

0.047

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 I69.965 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for I69.965

For I69.965 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 I69.965 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

I69.965 is the ICD-10-CM diagnosis code for other paralytic syndrome following unspecified cerebrovascular disease, bilateral. Weakness or paralysis affecting both sides of the body in a symmetrical or asymmetrical pattern following a stroke. I69.965 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, I69.965 maps to Monoplegia, Other Paralytic Syndromes (HCC 254) with a community, non-dual, aged base RAF weight of 0.321. Under the older V24 model, I69.965 mapped to the same category but with a base RAF weight of 0.331, 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.

Bilateral designation indicates involvement of both right and left sides; document whether the weakness is symmetrical or asymmetrical. Because I69.965 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 I69.965 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Bilateral designation indicates involvement of both right and left sides; document whether the weakness is symmetrical or asymmetrical
•This code is used for complex paralytic syndromes affecting multiple limbs on both sides of the body

Clinical Significance

Other paralytic syndromes following unspecified 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

•I69.86x: Other paralytic syndrome following other cerebrovascular disease; use when the specific type of cerebrovascular disease is documented
•I69.95x: Hemiplegia/hemiparesis following unspecified cerebrovascular disease; use when the paralysis follows a classic hemiplegic pattern
•I69.94x: Monoplegia of lower limb following unspecified 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