I69.261 — Other paralytic syndrome following other nontraumatic intracranial hemorrhage affecting right dominant side

Risk adjustment

I69.261 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 254 Monoplegia, Other Paralytic Syndromes0.321 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.

Medicare coverage

I69.261 is named in 9 Medicare coverage policies — 9 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

• A53057Billing and Coding: Home Health Occupational Therapy
• A53064Billing and Coding: Outpatient Occupational Therapy
• A53065Billing and Coding: Outpatient Physical Therapy
• A54095Billing and Coding: Nerve Conduction Studies and Electromyography