2026 ICD-10-CM Diagnosis Code I69.964Other paralytic syndrome following unspecified cerebrovascular disease affecting left non-dominant side
ICD-10-CM Codes›I00–I99›I60-I69›I69
- Billable — Valid for Submission
- Risk Adjusts — HCC 254
- POA Exempt
- Chronic Condition
I69.964 is a billable ICD-10-CM diagnosis code for other paralytic syndrome following unspecified cerebrovascular disease affecting left non-dominant side. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 56 through 57. The code is exempt from POA reporting. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Sequela of cerebral infarction and other cerebrovascular disease.
For Medicare Advantage risk adjustment, I69.964 maps to CMS-HCC Category 254 (Monoplegia, Other Paralytic Syndromes) under the V28 model, adding a risk factor of about 0.321 for a community, non-dual, aged beneficiary in payment year 2026.
Code Identity
Code Classification
Present on Admission (POA)Billing
I69.964 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
I69.964 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 2026.
Source: CMS Payment Year 2026 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.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
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
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Convert I69.964 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About I69.964Overview
Is I69.964 a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report other paralytic syndrome following unspecified cerebrovascular disease affecting left non-dominant side on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What MS-DRG does I69.964 group to?
When other paralytic syndrome following unspecified cerebrovascular disease affecting left non-dominant side is the principal diagnosis on an inpatient stay, it groups to MS-DRG 56, 57, with relative weights from 1.2956 to 2.3231 depending on complications. Higher weights mean higher Medicare reimbursement.
Is I69.964 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 other paralytic syndrome following unspecified cerebrovascular disease affecting left non-dominant side on inpatient claims. The code appears in the Cerebrovascular diseases (I60-I69) range of the CMS exempt list.
What is the ICD-9 equivalent of I69.964?
Under the General Equivalence Mappings, other paralytic syndrome following unspecified cerebrovascular disease affecting left non-dominant side converts to ICD-9-CM 438.52 (lt ef oth parals non-dom). The mapping is approximate, so confirm the match fits the documentation.
What HCC is I69.964?
I69.964 (other paralytic syndrome following unspecified cerebrovascular disease affecting left non-dominant side) maps to CMS-HCC Category 254 (Monoplegia, Other Paralytic Syndromes), commonly written as HCC 254, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2026. It mapped to HCC 104 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 I69.964 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, I69.964 adds a risk adjustment factor of about 0.321 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.000 to 0.365 depending on the payment segment). A more severe related category (HCC 180, HCC 181, HCC 191, HCC 192, and HCC 253) supersedes it when both are reported. See the full factor table on the HCC 254 category page.
