Understanding left-sided weakness? This resource provides information on hemiparesis, left-sided body weakness, left hemiplegia, cerebrovascular accident (CVA), stroke symptoms, muscle weakness causes, neurological exam findings, ICD-10 codes for left-sided weakness, clinical documentation improvement for hemiparesis, and healthcare guidance for managing left-sided weakness. Learn about diagnosis, treatment, and support for patients experiencing left-sided weakness.
Also known as
Hemiplegia and hemiparesis
Weakness or paralysis on one side of the body.
Other muscle weakness
Generalized or localized muscle weakness, not otherwise specified.
Cerebrovascular diseases
Conditions affecting blood vessels in the brain, often causing weakness.
Diseases of the nervous system
Broad category encompassing various neurological conditions, including weakness.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is weakness sudden onset?
Yes
Confirmed CVA/Stroke?
No
Known neurological condition?
When to use each related code
Description |
---|
Left-sided weakness |
Hemiparesis |
Left hemiplegia |
Coding left-sided weakness requires specific documentation of affected body areas (e.g., arm, leg, face) for accurate code assignment and avoiding unspecified codes.
Insufficient documentation linking left-sided weakness to a specific diagnosis (e.g., stroke, TIA, MS) may lead to inaccurate coding and impact reimbursement.
Improper distinction between weakness (paresis) and paralysis (plegia) can result in incorrect code selection, impacting quality reporting and severity measures.
Patient presents with left-sided weakness, also documented as left hemiparesis. Onset of symptoms was reported as [Date of onset] and characterized by [gradual/sudden] reduction in strength affecting the left arm and leg. The patient reports difficulty with [specific activities of daily living affected by weakness; e.g., gripping, lifting, walking, buttoning clothing]. Neurological examination reveals [describe specific findings, e.g., decreased muscle strength graded as [Medical Research Council Scale grade] in the left upper and lower extremities, hyperreflexia, positive Babinski sign on the left]. Differential diagnosis includes stroke, transient ischemic attack (TIA), cerebral palsy, multiple sclerosis, brain tumor, and peripheral neuropathy. Initial assessment suggests [leading suspected diagnosis, e.g., possible ischemic stroke]. Ordered [diagnostic tests, e.g., brain MRI with and without contrast, carotid ultrasound, complete blood count (CBC), basic metabolic panel (BMP)]. Plan is to admit the patient for [state reason for admission, e.g., further neurological evaluation and monitoring, stroke workup]. Treatment plan will be determined based on diagnostic findings. ICD-10 code considerations include [relevant ICD-10 codes, e.g., R29.898 Other specified abnormalities of gait and mobility, M62.81 Muscle weakness (generalized), G81.1 Hemiplegia and hemiparesis affecting predominantly right dominant side affecting left non-dominant side]. CPT codes for evaluation and management services will be determined based on complexity of medical decision making. Patient education provided regarding potential causes of left-sided weakness, diagnostic testing procedures, and plan of care. The patient verbalized understanding. Follow-up scheduled with neurology.