# Cva - with notes of patient



## arizona1 (Oct 14, 2009)

when office note states CVA in past medical hx but adds reviewed this DOS - with notes of patient using walker, wheelchair. Do you use 434.91 or the V code?


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## Rani (Oct 14, 2009)

Whenever there is a "residual" condition left over from a CVA such as hemiplegia, weakness, whatever--you Always use the 438.XX code.  You only use the V code when there are no late effects of the CVA.  Hope this helps.


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## LTibbetts (Oct 14, 2009)

Hope this will shed some light on the subject for you. Coding CVA is sometimes really tricky.


Cerebrovascular accident (CVA) with late effects 
******Coding Clinic, Second Quarter 1989 Page: 8 Effective with discharges: July 31, 1989  
******Related Information 


Cerebrovascular Accident with Late Effects 

In order to classify cerebrovascular accident (CVA) with late effects correctly, the coder should be aware that if the CVA culminates in neurological deficits, they occur immediately. 

Initial onset of CVA with neurologic deficits (hemiplegia, dysphagia, dysphasia, asphasia, and/or other paralysis, such as of eye muscles) are coded to categories 430--434 if the type of CVA is known, such as cerebral hemorrhage or thrombosis. Code also any neurologic deficit still present at the time of discharge. If the CVA is not further described, assign code 436, Acute, but ill-defined, cerebrovascular disease. Code also the neurologic deficit. 

Note from 3M:
 As of October 1, 1997, category 438 has been expanded to fourth and fifth digits to indicate specific types of late effects of cerebrovascular disease (e.g., aphasia (438.11), hemiplegia (438.2x), monoplegia (438.3x and 438.4x)).


The continuing presence of the neurologic deficit(s) following initial onset is coded and an additional code of 438, Late effects of cerebrovascular disease, is assigned. The second sentence in the "Note:" under code 438 should be interpreted as follows: 

(1) Sequelae (neurologic deficits), or 

(2) Present (neurologic deficits) one year or more after onset of the causal condition 

The reference to sequelae takes into consideration that in some cases the neurologic deficit diminishes or disappears within weeks or months of the CVA, while in other cases the neurologic deficits may remain permanently (present one or more years after). The degree of impairment varies from case to case. 

A late effect is the residual effect (condition produced) present after the termination of the acute phase of an illness or injury. The residual may be apparent, as in CVAs, or it may occur much later, as with a previous injury or illness. A "new CVA" is a repeat hemorrhage or thrombosis of a new or same site. 

©*Copyright 1984-2009, American Hospital Association ("AHA"), Chicago, Illinois. Reproduced with permission. No portion of this publication may be copied without the express, written consent of AHA.


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## arizona1 (Oct 14, 2009)

I'm sorry I have a mental block and just can't think this one through clearly. The DOS was written that the CVA was 1990 and patient is in for follow-ups. The CVA was written in PMH but then noted on document CVA - weak and using walker at home and wheelchair when out of home. 

Is this considered a residual from the time of the incident or late effects.

Thank you


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