ICD-10 I69.869
Billable / Specific HCC v28: 104Other paralytic syndrome following other cerebrovascular disease affecting unspecified side
About ICD-10-CM I69.869
ICD-10-CM code I69.869 represents Other paralytic syndrome following other cerebrovascular disease affecting unspecified side. This is a billable/specific code in the Circulatory System chapter (block I69). The 2026 edition of ICD-10-CM I69.869 became effective on October 1, 2025.
Coding Tips for I69.869
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
I69.869 is a CMS-HCC v28 risk-adjustment code (category 104). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Medicare LCD Coverage for I69.869
Local Coverage Determinations (LCDs) from CMS MACs that list I69.869 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing I69.869.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but I69.869 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with I69.869
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert I69.869 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| I69.869 | 43850 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To I69.869
Other codes in section I60-I69 (Cerebrovascular diseases).
ICD-10 I69.869, Billing FAQ
Is ICD-10 code I69.869 billable? +
Yes, I69.869 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does I69.869 affect Medicare Advantage HCC risk adjustment? +
Yes. I69.869 maps to CMS-HCC v28 category 104. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What ICD-9 codes does I69.869 map to? +
Per CMS GEMs, I69.869 maps to ICD-9 codes: 43850. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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