P91.823 ICD-10-CM Code: Neonatal cerebral infarction, bilateral

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for P91.823 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on P91.823 itself; “inherited from” names the category or block whose note applies here.

Coder workflow for P91.823

MedCoder structured workflow — derived from this code’s own official record

Before you code P91.823

1. Laterality is coded in this family. Confirm the side documented — right, left, or bilateral — and select the matching code (this page’s code: bilateral). The unspecified-side code applies only when the record states no side. Laterality is assigned from the documented side; where a bilateral code exists and both sides are documented, it is used instead of two unilateral codes (Guidelines I.B.13).

   See the relationships section · Guide: Laterality coding →

2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with P91.823. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

   See the official tabular notes

Choose the right path

1. Does the documentation support a condition named in P91.823’s Excludes1 note?
   Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
   No → Continue.

   ReviewI63

2. Is the side documented?
   Yes → Select the code for the documented side (or the bilateral code when both sides are documented and one exists).
   No → Use the unspecified-side code only when the record states no side; a query is the alternative.

Consider P91.823. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement

Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

Laterality

Right, left or bilateral as documented; unspecified only when the record states no side (Guidelines I.B.13).

Official instructions as workflow

• Excludes1 — check before selecting P91.823(1 note)

  Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with P91.823: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

  CompareI63

  See the official tabular notes · Guidelines I.A.12.a

• Excludes2 — not part of P91.823(1 note)

  Coding workflow: The conditions named in this note are not included in P91.823. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

  CompareP52

  See the official tabular notes · Guidelines I.A.12.b

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Don’t confuse P91.823 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of P91.823 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

• I63— Excludes1 conflict (Excludes1 — generally not reported together)

  Not coded here — the tabular list excludes this pair for the same encounter.

  Not reported together with this code, except where the two conditions are documented as unrelated.

  What moves you there: Documentation of cerebral infarction moves the case to I63; the two are not reported together unless documented as unrelated.

  Full comparison: P91.823 vs I63 →

• P91.829— Specificity relationship (Review)

  Overlapping diagnoses in the same category.

  Overlapping codes in the same category — the documentation decides which is the more specific fit.

  What moves you there: A record that documents no more than “Neonatal cerebral infarction, unspecified side” takes P91.829; specificity in the record moves it back here.

  Full comparison: P91.823 vs P91.829 →

• P52— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of intracranial hemorrhage of newborn adds P52; it is not part of this code and both may be reported when both are documented.

  Full comparison: P91.823 vs P52 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

1. Laterality is coded in this family. Confirm the documented side matches the code — the opposite-side siblings are in the relationships section. See the opposite-side sibling codes
2. 1 Excludes1 entry — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
3. 1 Excludes2 entry — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

• MCC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name P91.823 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 2 Excludes1 notes across 2 chapters: I63 — Cerebral infarction (via P91.82.-), P91.0 — Neonatal cerebral ischemia (via P91.82.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: MCC — Major Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 4 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 2 MS-DRGs: DRG 791 (MDC 15), DRG 793 (MDC 15).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):PNL004 — Neonatal cerebral disorders (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as MCC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

P91.821 — Neonatal cerebral infarction, right side of brain, P91.822 — Neonatal cerebral infarction, left side of brain, P91.829 — Neonatal cerebral infarction, unspecified side

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Ischemic or Unspecified Stroke) for risk-adjusted payment.

I63.521 — Cerebral infarction due to unspecified occlusion or stenosis of right anterior cerebral artery, I63.522 — Cerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral artery, I63.523 — Cerebral infarction due to unspecified occlusion or stenosis of bilateral anterior cerebral arteries, I63.529 — Cerebral infarction due to unspecified occlusion or stenosis of unspecified anterior cerebral artery, I63.531 — Cerebral infarction due to unspecified occlusion or stenosis of right posterior cerebral artery, I63.532 — Cerebral infarction due to unspecified occlusion or stenosis of left posterior cerebral artery, I63.533 — Cerebral infarction due to unspecified occlusion or stenosis of bilateral posterior cerebral arteries, I63.539 — Cerebral infarction due to unspecified occlusion or stenosis of unspecified posterior cerebral artery, I63.541 — Cerebral infarction due to unspecified occlusion or stenosis of right cerebellar artery, I63.542 — Cerebral infarction due to unspecified occlusion or stenosis of left cerebellar artery, I63.543 — Cerebral infarction due to unspecified occlusion or stenosis of bilateral cerebellar arteries, I63.549 — Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebellar artery, I63.59 — Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery, I63.6 — Cerebral infarction due to cerebral venous thrombosis, nonpyogenic, I63.81 — Other cerebral infarction due to occlusion or stenosis of small artery, I63.89 — Other cerebral infarction, I63.9 — Cerebral infarction, unspecified, P91.821 — Neonatal cerebral infarction, right side of brain, P91.822 — Neonatal cerebral infarction, left side of brain, P91.829 — Neonatal cerebral infarction, unspecified side, +74 more

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Intracranial Hemorrhage

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Neonatal cerebral disorders).

P90 — Convulsions of newborn, P91.0 — Neonatal cerebral ischemia, P91.1 — Acquired periventricular cysts of newborn, P91.2 — Neonatal cerebral leukomalacia, P91.3 — Neonatal cerebral irritability, P91.4 — Neonatal cerebral depression, P91.5 — Neonatal coma, P91.60 — Hypoxic ischemic encephalopathy [HIE], unspecified, P91.61 — Mild hypoxic ischemic encephalopathy [HIE], P91.62 — Moderate hypoxic ischemic encephalopathy [HIE], P91.63 — Severe hypoxic ischemic encephalopathy [HIE], P91.8 — Other specified disturbances of cerebral status of newborn, P91.811 — Neonatal encephalopathy in diseases classified elsewhere, P91.819 — Neonatal encephalopathy, unspecified, P91.821 — Neonatal cerebral infarction, right side of brain, P91.822 — Neonatal cerebral infarction, left side of brain, P91.829 — Neonatal cerebral infarction, unspecified side, P91.88 — Other specified disturbances of cerebral status of newborn, P91.9 — Disturbance of cerebral status of newborn, unspecified

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Stroke”, “Infarct, infarction”; these codes share that main term but sit in a different category of the Tabular List.

K86.89 — Other specified diseases of pancreas (pancreas), M62.20 — Nontraumatic ischemic infarction of muscle, unspecified site (muscle), M62.21 — Nontraumatic ischemic infarction of muscle, shoulder (muscle, shoulder region), M62.22 — Nontraumatic ischemic infarction of muscle, upper arm (muscle, upper arm), M62.23 — Nontraumatic ischemic infarction of muscle, forearm (muscle, forearm), M62.24 — Nontraumatic ischemic infarction of muscle, hand (muscle, hand), M62.25 — Nontraumatic ischemic infarction of muscle, thigh (muscle, thigh), M62.26 — Nontraumatic ischemic infarction of muscle, lower leg (muscle, lower leg), M62.27 — Nontraumatic ischemic infarction of muscle, ankle and foot (muscle, foot), M62.28 — Nontraumatic ischemic infarction of muscle, other site (muscle, specified site NEC), N28.0 — Ischemia and infarction of kidney (renal), N42.89 — Other specified disorders of prostate (prostate), N50.1 — Vascular disorders of male genital organs (testis), N64.89 — Other specified disorders of breast (breast), N83.8 — Other noninflammatory disorders of ovary, fallopian tube and broad ligament (ovary), O43.81 — Placental infarction (placenta), T67.01 — Heatstroke and sunstroke (sun), T67.02 — Exertional heatstroke (heat, exertional), T67.09 — Other heatstroke and sunstroke (sun, specified NEC), Z86.73 — Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits (cerebrovascular, chronic), +58 more

Contextual Map

Every relationship of P91.823 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run P91.823 with these 2 related codes in Claim Check

Hierarchy

• P00-P96 — Chapter 16: Certain Conditions Originating in the Perinatal Period (P00-P96) (P00-P96)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• P90-P96 — Other disorders originating in the perinatal period[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Referenced by Excludes1 notes

• I63 — Cerebral infarction[Excludes1](via P91.82.-): “neonatal cerebral infarction (P91.82-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• P91.0 — Neonatal cerebral ischemia[Excludes1](via P91.82.-): “Neonatal cerebral infarction (P91.82-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

• PNL004 — Neonatal cerebral disorders[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

Risk adjustment (CMS-HCC)

• HCC 249 — Ischemic or Unspecified Stroke [CMS-HCC]— CMS-HCC V28 · 2026

MS-DRG Grouper

• MCC — Major Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (MCC).”— CMS MS-DRG Definitions Manual (Appendix C) · FY2026
• DRG 791 — PREMATURITY WITH MAJOR PROBLEMS[MS-DRG]: “PREMATURITY WITH MAJOR PROBLEMS (MDC 15)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 793 — FULL TERM NEONATE WITH MAJOR PROBLEMS[MS-DRG]: “FULL TERM NEONATE WITH MAJOR PROBLEMS (MDC 15)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

MDC crossing

• MDC 15 — Newborns and Other Neonates with Conditions Originating in Perinatal Period[MDC crossing]: “Newborns and Other Neonates with Conditions Originating in Perinatal Period — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”— CMS MS-DRG Definitions Manual · FY2026

Nearest codes (22)

• P91 — Other disturbances of cerebral status of newborn[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• P91.0 — Neonatal cerebral ischemia[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• P91.1 — Acquired periventricular cysts of newborn[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• P91.2 — Neonatal cerebral leukomalacia[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• P91.3 — Neonatal cerebral irritability[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• P91.4 — Neonatal cerebral depression[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• P91.5 — Neonatal coma[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• P91.6 — Hypoxic ischemic encephalopathy [HIE][Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• and 14 more

Change history

• FY2021 — Added to the code set[Change history]— CMS release files (code change ledger) · icd10cm-fy2021

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data

CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page

Claim edits Official source data

CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page

Inpatient payment groups Official source data

CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page

Risk adjustment Official source data

2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page

Change history and date-of-service validity Official source data

CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page

Comparisons, relationships and the contextual map MedCoder structured relationship

Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears

Summary and FAQ answers MedCoder explanation

Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Nearest Codes in This Family

Official ICD-10-CM classifications closest to P91.823 in its code family, with their registry titles.

• P91.8 — Other specified disturbances of cerebral status of newborn
• P91.81 — Neonatal encephalopathy
• P91.811 — Neonatal encephalopathy in diseases classified elsewhere
• P91.819 — Neonatal encephalopathy, unspecified
• P91.82 — Neonatal cerebral infarction
• P91.821 — Neonatal cerebral infarction, right side of brain
• P91.822 — Neonatal cerebral infarction, left side of brain
• P91.829 — Neonatal cerebral infarction, unspecified side
• P91.88 — Other specified disturbances of cerebral status of newborn
• P91.9 — Disturbance of cerebral status of newborn, unspecified

View all codes in the P91 family