# Old CVA with residual left sided weakness



## Michelle2179

Assesment:  CVA with left sided weakness (unspecified dominant or nondominate sided)

By definition, hemiparesis = weakness, therefore I would conclude that the correct code would be 438.20 (late effect of CVA with hemiparesis/hemiplegia).  There are many debates, with out a concise direction, for this code I would appreciate some guidance, please 

Should I code 438.20
      -OR-
438.89 and 780.79


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## gost

The definition of hemiparesis is the partial paralysis of one side of the body, not weakness.  Go with 438.89.  Look at the tip under 438.89 in the ICD-9 expert.  Use 728.87 as your secondary code for residual weakness due to CVA.


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## Michelle2179

From the medical dictionary and stroke.about.com, the following are defined:

Hemiplegia: partial paralysis of one side of the body 
Hemiparesis: muscle weakness on one side of the body


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## gost

Michelle2179 said:


> From the medical dictionary and stroke.about.com, the following are defined:
> 
> Hemiplegia: partial paralysis of one side of the body
> Hemiparesis: muscle weakness on one side of the body



While sites like About.com and Wikipedia can sometimes be good starting points for research, they are by not alaways reliable resouirces for detailed information.  The best reference for diagnosis coding is the ICD-9 CM.  Again, refer to the coding tips under the entry for 438.89.  In addition, look up "paresis" in any medical dictionary.  Paresis is the partial loss of or impared movement.


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## arizona1

Have also defined Hemiparesis as weakness on one side of the body and use 438.20. 

Looking at the definition on the tabular list is does only state "paralysis"

Does anyone know if CMS has accepted this as weakness?


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## JulesofColorado

This is from The Coding Clinic, First Quarter 2005 Page: 13 


"Question: 

Please provide clarification on the correct code assignment for a residual deficit of muscle weakness secondary to late effect of cerebrovascular accident. We have a difference of opinion on whether this should be coded to code 438.2x, Late effects of cerebrovascular disease, hemiplegia/ hemiparesis. What is the appropriate code assignment for residual weakness that is a late effect of CVA? 


Assign code 438.89, Other late effects of cerebrovascular disease and code 728.87, Muscle weakness, for residual muscle weakness secondary to late effect of cerebrovascular accident."


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## arizona1

thank you!


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## LoveCoding

*Old CVA w/residual left sided weakness*

I just had this same DX.  In the encoder I put late/effect/CVA/hemiplegia/ unspecified (because it doesn't say whether left side was dominant or not.  The code comes up 438.20 and tabular confirms Hemiplegia/hemipararesis (Late effect of CVA).


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