# coding question - how would you code CVA



## arizona1 (Aug 7, 2009)

how would you code CVA with hemiparesis


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## LLovett (Aug 7, 2009)

I would clarify first with the provider but this is under late effects 438.2X. Again, clariy if this is a late effect or not before you use this code series.

Laura, CPC, CEMC


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## arizona1 (Sep 4, 2010)

Thank you.

If not a late effect and current would I be correct to use, 43491, 34290?
Thank you


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## preserene (Sep 5, 2010)

CVA - CerebroVascularAccident- it can be a hemmorragic or thromboembolic episode occuring there in the cerebral vasculature; it can be categorized as Cerebrovascular Insufficiency too. So it can be placed  *for coding under 436 Acute but illdefined cerebrovascular disease, apoplexy,NOS, attack,  OR 437.1- other generalized ischemic cerebrovascular disease, acute Cerebrovascular Insufficiency, depending on what was happening *(you can very well get it from the op notes of the physician or CT or MRI.
However, if it happened recently or an ongoing process in this visit, you can code it as 
436 or 437.1 as the primary diagnosis and438.2x (x for the side)- the hemiplegia following that. Most often, both CVA and Hemiplegia / Hemiperesis are simultaneous episodes. 
May be you can provide us with a note of the time of occurance or time of diagnosis of both to code appropriately
Hemiperesis/Hemiplegia is a sequlae happening due to the CVA, meaning, the underlying cause is CVA (the culprit for the Hemiplegia). 
If the CVA occurs at the right side, then the Hemiplegia occurs at the left side; if CVA at the left and then the hemiplegia occurs on the right side( meaning it affects the opposite side; that is what it means by 'dominant side' at this juncture.
So try any one of these two diagnostic Codes an dthe code for hemiperesis/hemiplegia.
 If the patient had HTN or DM add them as secondary diagnosis too. because CVA can  result due to these conditions too.


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## ohn0disaster (Sep 7, 2010)

If you are coding in an outpatient setting, you are almost never going to be coding cva as an acute event, as most outpatient facilities do not have the equipment to diagnose such an event. If a patient comes in with symptoms of a stroke, they are immediately sent for hospital eval. It is my understanding that it may only be coded as an acute event within 24 hours of the cva. With that being said, when the doc states CVA with *current* hemiparesis, it may be coded as 438.20 . This is a late effects code for hemiparesis due to CVA. I agree with Laura that you need to get the doctor to clarify this diagnosis because as it is stated above, there is not enough information to code as a CURRENT late effect and rather it falls into the History of category of V12.54. This is unless, of course, there is more documented about the CVA and hemparesis that you did not share. Hope this helps.


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## preserene (Sep 7, 2010)

I am not coming for the discussion if it is OV after discharge. It becomes follow up.
I am off the filed for that. 
all my info based on the on going events of CVA.
I would like to know the referrence and the rationale to say the CVA is acute first 24hrs,or to be coded  to "late effect" after 24hours of its occurrence?

My knowledge goes upto this only:-
CVA and Hemiplegia/hemiperesis:
When it is CVA diagnosed during the current episodeof care, it is not  for OV because she/he is a case for Inpatient Status. That is a known fact. Even if it is TIA.

If the patient comes to the doctor for follow up after getting discharged from the hospital for rehabilitation continuation and follow up treatment etc,  it is justifiable for OV code and the late effect of CVA. 
Even  though we need more info, in this case, how can you say that the CVA becomes “late effect “ after 24hours ,and hemiplegia as the current diagnosis, while setting aside the CVA as late effect.
What I try to say is, code CVA as the primary diagnosis as long it has an on going effect;  she in the hospital, till she is out of danger –morbidity or mortality threats.
It is so puzzling, having known the course and effects and the need for acute care for quite a longer period of time  to pronounce she/he is improving, independant, dependant or going to be dead in the course of time, meaning, while the care is acute still need to be  prolonged to pronounce the patient is being out of danger zone. It takes many days, months to years even.
CVA is defined as the onset of a new neurological deficit that occurred as a rapid(acute) event, with signs and symptoms corresponding to the involvement of focal areas of the brain .
 An established and universally accepted definition for stroke is "acute neurologic dysfunction of vascular origin . . . with symptoms and signs corresponding to the involvement of focal areas of the brain leading to the infarction of brain tissue.
 A stroke is distinguished from a transient ischemic attack (TIA) by the fact that neurological deficits in TIAs clear spontaneously within 24 hours. 
knowing the severity, morbidity and mortality of the disease (CVA) , its course and outcome ,how  would we place it to “late effect” code 
Are we placing the Diabetes mellitus and HTN onto the late effect when the sequlae is still on going ?
Our point of discussion is CVA and not TIA (TIA has a separate code).
The term acute  in relation to CVA is about its rapid onset ,no matter whatever the underlying cause .But the Hemiperesis and hemiplegia is only a sequale or sign which occurs as a consequence of CVA. Pt admitted in hospital with CVA as the primary diagnosis will continue to have the same diagnosis till discharge from the hospital; and with the chances of recurrence any time again. When there is an underlying cause or a pathology , you would not code that?
All about the event of CVA are acute be it signs, symptoms, studies, lab, and surgical, medical management of stroke during that stay until the rehabilitation starts.
How do you fix it 24hrs, even the doctors cannot say the high risk, life threatening period is  over or not in 24 hours , days and even months.
Would You know that those patients with CVA are in the inpatient status for months even years!
Length of stay for the first episode of care by OCSP category, at admission and functional outcome at 6,12, and 12 months)
Average length of stay for first stroke was closely related to functional outcome at 6 months: alive and independent  14 days, alive but dependent  51 days, and dead 33 days.15
Do you know,  more over,  it is a MRI and CT diagnosis again to say that the clots or thrombus, or the hemorrhageor the cause is cleared off  and no more immediate threat or not; and to correlate the outcome in patients with ischemic stroke.
When it comes to the info, I do accept we could arrive to the accuracy based on that only. 
My info is not arguementative but just to have the basic knowledge so that when we get there  with the right info and reports for coding, to be in a better place !!
Thank you.


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