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National Stroke Awareness Month

Coding Educator, May 17, 2010

By: Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CCDS

May is National Stroke Awareness Month, and an opportune time to learn some of the ways to identify risks and increase recognition of America’s third leading cause of death.

A stroke occurs when the blood supply to a part of the brain is interrupted or reduced, depriving the brain tissue of oxygen and nutrients, according to the Mayo Clinic. Within minutes brain cells begin to die, thus putting emphasis on early recognition signs of a stroke.

When it comes to stroke recognition, acting F.A.S.T. is the best course of action, according to the National Stroke Association:

Face: Ask the person to smile. Does one side of the face droop?

Arms: Ask the person to raise both arms. Does one arm drift downward?

Speech: Ask the person to repeat a simple sentence. Are the words slurred? Can he/she repeat the sentence correctly?

Time: If the person shows any of these symptoms, time is important. Call 911 or get to the hospital fast. Brain cells are dying.

Coding Tips And Guidelines

In addition to recognizing stroke symptoms, there are also a number of ways to identify controllable risk factors, including high blood pressure, atrial fibrillation, high cholesterol, diabetes, tobacco use and smoking, alcohol use, physical inactivity and obesity. However, there are a number of uncontrollable risk factors, which makes stroke recognition even more crucial. These include age, gender, race, family history, previous stroke, fibromuscular dysplasia and patent foramen ovale (a defect in the septum (wall) between the two upper (atrial) chambers of the heart.)

When assigning codes for strokes, it is important to know that ICD-9-CM has three general categories of codes:

•  Ischemic – ICD-9-CM categories (433.xx and 434.xx)
• Hemorrhagic – ICD-9-CM categories (430-432)
• Transient ischemic attack – ICD-9-CM category (435.x)

A common occurrence in stroke patients may include the necessity to report for sequelae, (late effects or residuals associated with a stroke event.) The coding of these conditions will depend upon the time frame (i.e. admission).

For residuals from the current admission where the acute stroke occurred, the conditions are coded as current conditions with or without treatment even if they resolve prior to discharge. Coding Clinic, Vol. 27 No 1, 1st Qtr 2010>

For example - hemiplegia, unspecified side 342.90

For residuals from a previous admission where the stroke occurred, the conditions should be assigned a code from category 438.xx—late effects of cerebrovascular disease.

For example – late effect of CVA, hemiplegia, unspecified side (438.20)

For patients who have suffered a stroke (or TIA) in the past but have no residual effects should be assigned code V12.54, personal history of CVA/TIA.

In addition to being the third leading cause of death in America, strokes are also a leading cause of disability. However, early detection of a stroke and identifying controllable risk factors; coupled with spreading this knowledge to others, will only help reduce the incidence and impact of strokes throughout the country.

For more information on National Stroke Awareness month, visit the National Stroke Association Web site here: http://www.stroke.org/site/PageNavigator/HOME?cvridirect=true

And for an easy-to-use stroke risk scorecard, click here: http://www.stroke.org/site/DocServer/Scorecard.Q._08.pdf?docID=601

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