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Ask the ICD-10 Experts


A patient has residual right sided weakness but the doctor also states new onset of right sided weakness. Hemiplegic migraine was mentioned, but then the doctor decided it was a complicated migraine. How would the new onset of right-sided weakness be coded if the patient also has the residual right-sided weakness from a previous stroke? Thank you.


Hemiplegic migraine is a complex neurological disorder.  It generally includes headaches but not always.  Some of the "stroke-like" symptoms can include temporary disturbances in the following:
  • vision
  • muscle control and body sensations, e.g., numbness, weakness or paralysis on one side of the body, which can include the arm, leg and or side of face.
  • speech and language
  • hearing
Since the physician mentioned new onset of right-sided weakness, I would use code R53.1 Weakness accordingly. Remember, the ICD-10-CM Official Guidelines for Coding and Reporting FY 2016 Guideline .I.C.6.a , does provide direction on assignment of Sequelae of CVA codes I69.35*, I69.33* and I69.34* (6th digit required) for the side of the body affected by hemiplegia/hemiparesis and monoplegia of the upper and lower limbs.

When the affected side is specified but documentation does not indicate if it is the dominant or non-dominant side, and a default code is not included in the classification, the following guidelines should be following:
When the left side is affected, the default is non-dominant.
When the right side is affected, the default is dominant

This guideline also states that, for patients that are ambidextrous, the default should be dominant.

Leola Burke, MHSA, CCS, AHIMA-Approved ICD-10-CM/PCS Trainer, is an Independent ICD-10 Consultant.

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Hi Good morning,
I would like to get clarified on neurogenic claudication coding along with spinal stenosis or spondylosis. Could neurogenic claudication codded as an additional code if the patient underwent spinal fusion for stenosis. If added as a Sdx, it comes as MCC. Kindly clarify

Thank you

Lino John

LINO JOHN,  SME Inpatinet coding,  SysinformationFebruary 24, 2016


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