Cardiology Coding Alert

Hint: Report codes for intraoperative or postprocedural CVAs with caution.

Think you made an A+ on the cerebrovascular accident (CVA) and disease coding quiz on page83? Test your knowledge and check your answers.

Answer 1: A CVA is a stroke or cerebral infarction. If the cardiologist documents a stroke or CVA with no additional info, then you would report the default code, which is I63.9 (Cerebral infarction, unspecified).

Answer 2:  When you report a code for an intraoperative or postprocedural cerebrovascular accident, you must verify that the documentation clearly identifies the cause-and-effect relationship between the medical intervention and the cerebrovascular accident, per the guidelines. Then, you will report the appropriate code based upon whether the incident was an infarction or hemorrhage and whether it occurred intraoperatively or postoperatively. Additionally, if the patient suffers from a cerebral hemorrhage, then you would report the proper code based upon the type of procedure the cardiologist performed.

Answer 3: In some cases, patients might have sequela, late effects, that develop as a result of the CVA.

In these cases, “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,” per the guidelines.

“These “late effects” include neurologic deficits that persist after initial onset of conditions classifiable to categories I60- through I67-,” the guidelines continue. “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- through I67-.”

Answer 4: In the case of the affected side not being specified as dominant or nondominant and the classification system not indicating a default, your code selection should be as follows:

• 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.

Answer 5: True. Codes from category I69- may be assigned on a healthcare record with codes from I60- through I67-, if the patient has a current cerebrovascular disease and deficits from an old cerebrovascular disease.

Answer 6: False. You should not report codes from category I69- if the patient does not have neurologic deficits, according to the guidelines.