2027 ICD-10-CM Diagnosis Code I69.959Hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting unspecified side

ICD-10-CM Codes›I00–I99›I60-I69›I69

ICD-10-CM I69.959
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

I69.959 is a billable ICD-10-CM diagnosis code for hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting unspecified side. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 56 through 57. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 6 closely related codes. The code is flagged as an unspecified code, since codes identifying laterality exist in the same family and exempt from POA reporting. Coders also document this condition as hemiparesis as late effect of cerebrovascular disease. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Sequela of cerebral infarction and other cerebrovascular disease.

For Medicare Advantage risk adjustment, I69.959 maps to CMS-HCC Category 253 (Hemiplegia/Hemiparesis) under the V28 model, adding a risk factor of about 0.387 for a community, non-dual, aged beneficiary in payment year 2027.

Code Identity

ICD-10-CM Code
I69.959
Billable Status
Yes — Valid for Submission
Code Describes
Hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting unspecified side
Short Description
Hemiplga following unsp cerebvasc disease aff unsp side
Parent Code
I69.95
Hemiplegia and hemiparesis following unspecified cerebrovascular disease

Code Classification

ChapterI00–I99Diseases of the circulatory system
SectionI60-I69Cerebrovascular diseases
CategoryI69Sequelae of cerebrovascular disease
This CodeI69.959Hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting unspecified side

Code EditsBilling

Medicare Code Editor checks that affect claim validity for I69.959.

Unspecified codes
Unspecified codes exist in the ICD-10-CM classification for circumstances when documentation in the medical record does not provide the level of detail needed to support reporting a more specific code. However, in the inpatient setting, there should generally be very limited and rare circumstances for which the laterality (right, left, bilateral) of a condition is unable to be documented and reported. The following pages contain the list of unspecified ICD-10-CM diagnosis codes for which there is a more specific code to identify laterality (right, left, bilateral) within that code family.

Present on Admission (POA)Billing

I69.959 is exempt from POA reporting on inpatient claims to general acute care hospitals. Review the other POA exempt codes in Cerebrovascular diseases (I60-I69).

Medicare Risk Adjustment (HCC)Billing

I69.959 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.

CMS-HCC V28 Category (Payment Model)
HCC 253— Hemiplegia/Hemiparesis
Payment HCC · PY 2027 one of 45 ICD-10-CM codes in this category
Risk Adjustment Factor (RAF) Weight
+0.387
community, non-dual, aged · ranges 0.000–0.437 across segments
Hierarchy
Superseded by HCC 180, HCC 191, and HCC 192
a more severe related category takes the payment when both are reported
Prior Model (CMS-HCC V24)
HCC 103
V24 retired V28 pays 100% of MA risk scores since PY 2026
Other CMS Models
PACE (CMS-HCC V22): HCC 103 · ESRD (V21): HCC 103 · ESRD (V24): HCC 103
ESRD V21 weights: 0.086 dialysis, 0.000–0.467 functioning graft · ESRD V24 weights: 0.071 dialysis, 0.013–0.414 functioning graft
Part D (RxHCC)
Not mapped
I69.959 does not risk-adjust in the RxHCC prescription drug model

Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Hemiparesis as late effect of cerebrovascular disease
  • Hemiplegia as late effect of cerebrovascular accident
  • Hemiplegia as late effect of cerebrovascular disease
  • Hemiplegia as late effect of hemorrhagic stroke
  • Hemiplegia of dominant side as late effect of cerebrovascular disease
  • Hemiplegia of dominant side due to and following hemorrhagic cerebrovascular accident
  • Hemiplegia of nondominant side as late effect of cerebrovascular disease
  • Hemiplegia of nondominant side due to and following hemorrhagic cerebrovascular accident
  • Paralytic syndrome of dominant side as late effect of stroke
  • Paralytic syndrome of nondominant side as late effect of stroke

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to I69.959: its own notes plus those printed at I69.9, I69, block I60-I69, and Chapter 9. A note printed at a category, block or chapter applies to every code under it.

Excludes1

Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.

From I69.9 Sequelae of unspecified cerebrovascular diseases applies to 40 codes
  • sequelae of stroke (I69.3)
  • sequelae of traumatic intracranial injury (S06.-)
From I69 Sequelae of cerebrovascular disease applies to 240 codes
  • personal history of cerebral infarction without residual deficit (Z86.73)
  • personal history of prolonged reversible ischemic neurologic deficit (PRIND) (Z86.73)
  • personal history of reversible ischemic neurologcial deficit (RIND) (Z86.73)
  • sequelae of traumatic intracranial injury (S06.-)
From Block I60-I69 Cerebrovascular diseases applies to 410 codes
  • traumatic intracranial hemorrhage (S06.-)

Excludes2

Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.

From Chapter 9 (I00-I99) Diseases of the circulatory system applies to 1,433 codes
  • certain conditions originating in the perinatal period (P04-P96)
  • certain infectious and parasitic diseases (A00-B99)
  • complications of pregnancy, childbirth and the puerperium (O00-O9A)
  • congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
  • endocrine, nutritional and metabolic diseases (E00-E88)
  • injury, poisoning and certain other consequences of external causes (S00-T88)
  • neoplasms (C00-D49)
  • symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
  • systemic connective tissue disorders (M30-M36)
  • transient cerebral ischemic attacks and related syndromes (G45.-)

Use Additional Code

Add a second code, after this one, to fully describe the condition.

From Block I60-I69 Cerebrovascular diseases applies to 410 codes
  • code to identify presence of:
  • alcohol abuse and dependence (F10.-)
  • exposure to environmental tobacco smoke (Z77.22)
  • history of tobacco dependence (Z87.891)
  • hypertension (I10-I1A)
  • occupational exposure to environmental tobacco smoke (Z57.31)
  • tobacco dependence (F17.-)
  • tobacco use (Z72.0)

Notes

General instructions on how these codes are used.

From I69 Sequelae of cerebrovascular disease applies to 240 codes
  • Category I69 is to be used to indicate conditions in I60-I67 as the cause of sequelae. The 'sequelae' include conditions specified as such or as residuals which may occur at any time after the onset of the causal condition

Source: CMS ICD-10-CM Tabular List. How to read instructional notes.

Referenced in Other NotesGuidance

Instructional notes printed at other codes that name I69.959, its category, or a range that includes it.

Excludes1 13

These codes carry an Excludes1 note naming I69.959: they are not reported together with it, unless the two conditions are unrelated.

  • F80.81 Childhood onset fluency disorder
    fluency disorder (stuttering) following cerebrovascular disease (I69. with final characters -23) names I69, which includes this code
  • F98.5 Adult onset fluency disorder
    fluency disorder (stuttering) following cerebrovascular disease (I69. with final characters -23) names I69, which includes this code
  • G81 Hemiplegia and hemiparesis
    hemiplegia and hemiparesis due to sequela of cerebrovascular disease (I69.05-, I69.15-, I69.25-, I69.35-, I69.85-, I69.95-) names I69.95-, which includes this code
  • I69.96 Other paralytic syndrome following unspecified cerebrovascular disease
    hemiplegia/hemiparesis following unspecified cerebrovascular disease (I69.95-) names I69.95-, which includes this code
  • R27.0 Ataxia, unspecified
    ataxia following cerebrovascular disease (I69. with final characters -93) names I69, which includes this code
  • R29.810 Facial weakness
    facial weakness following cerebrovascular disease (I69. with final characters -92) names I69, which includes this code
  • R47.01 Aphasia
    aphasia following cerebrovascular disease (I69. with final characters -20) names I69, which includes this code
  • R47.02 Dysphasia
    dysphasia following cerebrovascular disease (I69. with final characters -21) names I69, which includes this code
  • R47.1 Dysarthria and anarthria
    dysarthria following cerebrovascular disease (I69. with final characters -22) names I69, which includes this code
  • R47.8 Other speech disturbances
    dysarthria following cerebrovascular disease (I69. with final characters -28) names I69, which includes this code
  • R47.82 Fluency disorder in conditions classified elsewhere
    fluency disorder (stuttering) following cerebrovascular disease (I69. with final characters -23) names I69, which includes this code
  • R48.2 Apraxia
    apraxia following cerebrovascular disease (I69. with final characters -90) names I69, which includes this code
  • Z86.73 Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits
    sequelae of cerebrovascular disease (I69.-) names I69.-, which includes this code

Code First 2

These codes say to code first a condition named in the note, and I69.959 is one of the conditions named.

  • F48.2 Pseudobulbar affect
    sequelae of cerebrovascular disease (I69.-) names I69.-, which includes this code
  • R13.1 Dysphagia
    if applicable, dysphagia following cerebrovascular disease (I69. with final characters -91) names I69, which includes this code

Notes 1

These notes mention I69.959.

  • I69 Sequelae of cerebrovascular disease
    Category I69 is to be used to indicate conditions in I60-I67 as the cause of sequelae. The 'sequelae' include conditions specified as such or as residuals which may occur at any time after the onset of the causal condition names I69, which includes this code

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR CIR025
Sequela of cerebral infarction and other cerebrovascular disease
Default principal diagnosis: inpatient Yes · outpatient Yes

Patient EducationClinical

Brain Diseases

Your brain is the control center of your body. It controls your thoughts, memory, speech, and movement. It regulates the function of many organs. It's part of your nervous system, which also includes your spinal cord and peripheral nerves. The nervous system sends signals between your brain and the rest of the body.

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert I69.959 to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
438.20 Late ef-hemplga side NOS
Approximate The match is approximate rather than exact.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About I69.959Overview

Is I69.959 a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting unspecified side on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What MS-DRG does I69.959 group to?

When hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting unspecified side is the principal diagnosis on an inpatient stay, it groups to MS-DRG 57, 56, with relative weights from 1.2835 to 2.2649 depending on complications. Higher weights mean higher Medicare reimbursement.

Is I69.959 a CC or MCC?

CMS lists I69.959 as a CC (complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 6 closely related codes in its exclusion list.

Is I69.959 exempt from POA reporting?

Yes. CMS lists this code among those exempt from present on admission reporting, so hospitals do not assign a POA indicator for hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting unspecified side on inpatient claims. The code appears in the Cerebrovascular diseases (I60-I69) range of the CMS exempt list.

Can I69.959 be reported with I69.3?

Not as a rule. The Excludes1 note at I69.9, which applies to I69.959, lists "sequelae of stroke (I69.3)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).

What HCC is I69.959?

I69.959 (hemiplegia and hemiparesis following unspecified cerebrovascular disease affecting unspecified side) maps to CMS-HCC Category 253 (Hemiplegia/Hemiparesis), commonly written as HCC 253, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 103 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. It does not map to any RxHCC in the Part D prescription drug model.

Does I69.959 risk-adjust for Medicare Advantage payment?

Yes. When documented and reported on a Medicare Advantage encounter, I69.959 adds a risk adjustment factor of about 0.387 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.000 to 0.437 depending on the payment segment). A more severe related category (HCC 180, HCC 191, and HCC 192) supersedes it when both are reported. See the full factor table on the HCC 253 category page.