# Dual coding - Current TIA with CVA residuals



## trinalankford (Jul 8, 2015)

We are dual coding ER charts right now, and my patient has a current TIA with residuals from a prior CVA of generalized weakness and dysarthria.

I attempted to code these conditions through my Encoder and then through my Coding Book but got an Excludes1 note that I can't use these codes together (codes I69.328 and I69.398 should not be used in conjunction with G45.9 per Excludes1 notes).

G45.9 - TIA, unspecified
I69.328 - Other speech and language deficits following cerebral infarction
I69.398 - Other sequelae of cerebral infarction
R53.1 - Weakness

I can see in the guidelines where you can use the CVA sequelae codes (I69 codes) with a current CVA (I60-I67), but you can't use the CVA sequelae codes with a current TIA. That does not make sense to me.

Am I missing something here, or will this patient simply have the G45.9 code for the current TIA, disregarding his sequelae codes?

Thank you!


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## mitchellde (Jul 8, 2015)

Unfortunately the exclude 1 note will prevale, so you cannot code them together.  I feel that many of the exclude 1 notes do not make sense but unfortunately it is what we have.  These things can possibly change as the code set is used and these faults come to light.  There is a form on the CDC website that you can fill out and submit to the committee that meets twice a year to determine code changes.  There is no guarantee that anything will be chNged as a result, but you will have the satisfaction of knowing you tried.


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## trinalankford (Jul 10, 2015)

mitchellde said:


> Unfortunately the exclude 1 note will prevale, so you cannot code them together.  I feel that many of the exclude 1 notes do not make sense but unfortunately it is what we have.  These things can possibly change as the code set is used and these faults come to light.  There is a form on the CDC website that you can fill out and submit to the committee that meets twice a year to determine code changes.  There is no guarantee that anything will be chNged as a result, but you will have the satisfaction of knowing you tried.



Thank you so much for your help!  I may just have to do that.


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