ED Coding and Reimbursement Alert

Question: We often see patients with cerebral transient ischemic attacks (TIAs), but coding for them is confusing. Could you break each type of TIA down along with the corresponding diagnosis codes?

Oklahoma Subscriber

Answer: Just about all of the cerebral TIA ICD-10 codes you’ll need are all located in the G45.- (Transient cerebral ischemic attacks and related syndromes) subsection of your manual.

From there, things get a bit complicated, as none of the TIAs are actually referred to as “transient ischemic attack” in their descriptors. Here’s the codes you’ll be choosing from for specified cerebral TIAs, along with explanations of the conditions, per Codify by AAPC:

• G45.0 (Vertebro-basilar artery syndrome) refers to a loss of blood flow in the cerebellum and brainstem; it could last a few minutes or a few hours.
• G45.1 (Carotid artery syndrome (hemispheric)) refers to blockage in blood vessels that supply blood to carotid arteries; this blockage is caused by plaque deposits, narrowed arteries, or blood flow-blocking clots.
• G45.2 (Multiple and bilateral precerebral artery syndromes) refers to blockage of carotid and basilar arteries; this blockage is caused by plaque deposits, narrowed arteries, or blood flow-blocking clots.
• G45.3 (Amaurosis fugax) refers to brief eyesight loss in one or both eyes; this could last a few seconds or several minutes, and is caused by lack of blood flow to the retina.
• G45.4 (Transient global amnesia) refers to a brief episode of memory loss and confusion that isn’t caused by a common neurological condition (epilepsy, stroke, head injury, etc.). This condition is exceedingly rare.

If none of the above diagnoses fits the bill, you might want to opt for G45.8 (Other transient cerebral ischemic attacks and related syndromes); if you use this code, be sure to include a description of the condition as to explain why the less-specific G45.8 code is appropriate. If the notes indicate that the TIA was simply “TIA” — or it is classified as a “spasm of cerebral artery” or “transient cerebral ischemia NOS” — choose G45.9 (Transient cerebral ischemic attack, unspecified).