Coding, Classification & Reimbursement

Coding clarification for Stroke with deficit followed by TIA

  • 1.  Coding clarification for Stroke with deficit followed by TIA

    Posted 10 days ago

    Need some guidance in coding the following for an annual assessment.

     

    The patients 1st  Stroke occurred 2016 – that resulted in the following code of  I69.354  Hemiplegia and hemiparesis following a cerebral infarction affecting left non-dominant side   

    On 10/5/2018 the patient had a TIA/Cerebral infarct without any residual deficit. Per guideline we do not code both I69.354 and Z86.73 so how would I capture the recent TIA/infarct?  

     

    Thank you for any and all feedback.

     

    Janet  Norton RN, BSN, CPC, CRC, CCM

     

     

     

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  • 2.  RE: Coding clarification for Stroke with deficit followed by TIA

    Posted 10 days ago
    Codes from category I69 and Personal history of
    transient ischemic attack (TIA) and cerebral infarction  (Z86.73)

    Codes from category I69 should not be assigned if the patient
    does not have neurologic deficits.

    Per 2018 guidelines above that i69 should not be assigned if the patient does not have neurologic deficits. And in your case the patient has neurologic deficits and an old one. And the excludes 1 note say there is an exception, when the two condition are unrelated to each other. In this case the two Strokes are unrelated, because they happen in different year. So I would code I69.354 and z86.73. This could be a case that the stroke that happen on 10/05/2018 would be consider recent and coded to I63.9 and I69.354, but there is not a guideline on how old the stroke have to be to code for history. Maybe we can get some more experience coder to help us out, because this is a very good question.

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    Wendy Johnson
    Medical Coder
    Chicot Memorial Hospital
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  • 3.  RE: Coding clarification for Stroke with deficit followed by TIA

    Posted 9 days ago
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    The Z86.73 would cover both TIA/infarct. You can't code any code twice. There is no way to code it twice, the information would still be in the medical record.

     

    Brenda Mohs, RHIT

    Home Health & LTC Medical Coder

    Essentia Health

    Brenda.Mohs@Essentia Health.org

     




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  • 4.  RE: Coding clarification for Stroke with deficit followed by TIA

    Posted 9 days ago
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    I misunderstood your question. You would code both I69.354 and Z86.73. Even though there is an Excludes 1 note, the two codes cover two different unrelated encounters so it is appropriate to code both.

     

    Brenda Mohs, RHIT

    Home Health & LTC Medical Coder

    Essentia Health

    Brenda.Mohs@Essentia Health.org

     




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  • 5.  RE: Coding clarification for Stroke with deficit followed by TIA

    Posted 9 days ago
    Thanks Brenda, that was my thought also.
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