Cardiology Coding Alert

Only report code from category I69- if patient has neurologic deficits.

The ICD-10-CM Official Guidelines for Coding and Reporting offer numerous instructions you can follow to keep your claims in check. Having to report a cerebrovascular accident (CVA), also known as a stroke, is no different. If you submit the incorrect claims, you could be jeopardizing your reimbursement.

Take a look at these frequently asked questions (FAQs) and correlating answers to ensure you know how to report CVAs in your practice.

Observe Important Intraoperative and Postprocedural CVA Rules

FAQ 1: How do I know if I can report an ICD-10-CM code for an intraoperative or postprocedural CVA?

Answer: The ICD-10-CM guidelines mandate when you can appropriately report an ICD-10-CM code for an intraoperative or postprocedural CVA. Follow these rules:

• The documentation must identify the cause-and-effect relationship between the medical intervention and the CVA.
• You must choose the appropriate ICD-10-CM code based on whether the accident was an infarction or hemorrhage. If it is a cerebral hemorrhage, the code assignment will depend upon the procedure the cardiologist performed.
• You must know whether the CVA occurred intraopera­tively or postoperatively.

Category I69- Covers Cognitive Deficits Following Cerebro­vascular Disease

FAQ 2: What codes should I report if my cardiologist documents the patient as having cognitive deficits following cerebrovascular disease?

Answer: If your cardiologist documents the patient as having cognitive deficits following cerebrovascular disease, look to codes from category I69- (Sequelae of cerebrovascular disease).

“Category I69- is used to indicate conditions classifiable to categories I60- [Nontraumatic subarachnoid hemorrhage] through I67- [Other cerebrovascular diseases] as the causes of sequela (neurologic deficits), themselves classified elsewhere,” according to the ICD-10-CM guidelines. “These ‘late effects’ include neurologic deficits that persist after initial onset of conditions classifiable to categories I60-I67.”

You should only report a code from category I69- if the patient has neurologic deficits, per the guidelines. Additionally, “the neurologic deficits caused by cerebrovascular disease may be present from the onset or may arise at any time after the onset of the condition classifiable to categories I60-I67.”

Example: An example of a code you will see in this category is I69.010 (Attention and concentration deficit following nontraumatic subarachnoid hemorrhage).

Focus on Hemiplegia, Hemiparesis, and Monoplegia

FAQ 3: According to the ICD-10-CM guidelines, some of the codes from category I69- mention hemiplegia, hemiparesis, or monoplegia. What are these conditions, and can you give an example of some of those codes?

Answer: Hemiplegia is muscle weakness or partial paralysis on one side of the body that can affect the arms, legs, and facial muscles. Hemiplegia is paralysis on one side of the body. Monoplegia is a type of paralysis that impacts one limb. Some of the codes you will see in category I69- that mention those conditions are the following:

• I69.151 (Hemiplegia and hemiparesis following nontraumatic intracerebral hemorrhage affecting right dominant side)
• I69.031 (Monoplegia of upper limb following nontraumatic subarachnoid hemorrhage affecting right dominant side)

Don’t miss: From the above code descriptors, you will notice that ICD-10-CM gives you code choices identifying whether the patient’s dominant or nondominant side was affected. For example, both I69.151 and I69.031 specify that the right side was affected.

Physician Didn’t Specify Dominant Side? Do This

FAQ 4: My cardiologist documented the patient’s affected side, but they did not specify the condition as dominant or non-dominant, and the classification system did not indicate a default. How should I handle this?

Answer: In this case, you will choose the appropriate ICD-10-CM code based on the following:

• For ambidextrous patients, the default should be dominant.
• If the left side is affected, the default is non-dominant.
• If the right side is affected, the default is dominant.

Carefully Report These Codes Together

FAQ 5: Are there any circumstances under which I can report codes from category I69- along with codes from categories I60- through I67-?

Answer: Yes. If your cardiologist documents that the patient has a current cerebrovascular disease and deficits from an old cerebrovascular disease, you can report the appropriate codes from category I69-, along with the appropriate codes from categories I60- through I67- on your claim, according to the guidelines.

“There are numerous choices when selecting a code from the I69- category, and it’s important to know what type of deficits the patient may have such as cognitive deficits, which are broken down even further to the type of cognitive deficit, such as a memory or visuospatial deficit,” says Robin Peterson, CPC, CPMA, manager of professional coding and compliance services, Pinnacle Enterprise Risk Consulting Services, LLC in Centennial, Colorado. “It’s important to work with your physicians and educate them on what documentation is needed to accurately report the sequelae of cerebrovascular disease.”