# Auditing subsequent care visit



## graciejean (Mar 15, 2010)

A patient with a newly diagnosed stroke is seen by the neurologist in follow up. A detailed exam is performed. For MDM notes:
 R hemispheric infarct
 repeat CT head R (illegible word) infarct with hemorrhagic (illegible word)
 will check MRI head tomorrow to determine extent of stroke/hematoma
 will hold antithrombolytics for now
 will follow.

The overall risk I can see is high, but the established diagnosis of rt hemispheric infarct would be 2 points for est problem worsening due to hemorrhagic... MDM would only meet low 99231. 
Is there a possibility that the hemorrhage would be the second problem for another 2 points to make this high MDM?


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## graciejean (Mar 16, 2010)

*Help-diagnosis code*

In this scenario would there be one diagnosis of 434.91 for the Rt hemispheric infarct? or would there a second diagnosis code for rt hemispheric infarct with hemorrhagic (illegible word)?


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