General Surgery Coding Alert

Payers are already gearing up to require 434.91

Come Oct. 1, you're going to have to apply a different diagnosis code for stroke patients. Now you report stroke or cerebrovascular accident (CVA) using ICD-9 code 436 (Acute, but ill defined, cerebrovascular disease), but for the coming year (beginning in October) you should instead choose existing code 434.91 (Cerebral artery occlusion, unspecified, with cerebral infarction) to describe this condition.

"Code 436 is somewhat vague and is not always included on Medicare coverage policies," says Jackie Miller, MA, CPC, senior consultant at Coding Strategies Inc., a healthcare reimbursement consulting firm in Dallas, Ga.

In contrast, she continues, "434.91 is a much more specific code that is more likely to be covered for imaging of the head, for instance. For example, I was looking over the Empire Medicare hospital coverage policy for MRA of the head and neck [e.g., 70544, Magnetic resonance angiography, head; without contrast materials(s)], and these exams are not covered for 436 but are covered for 434.91."

Surgeons might order MRAs and other diagnostic tests for stroke patients, and you should be sure to use 434.91, beginning Oct. 1, to indicate a stroke or CVA diagnosis. And when the surgeon treats stroke-related conditions, you may refer to 434.91 as a secondary (underlying) diagnosis.

Before October rolls around, you should also be sure to update your diagnosis coding for deep vein thrombosis (DVT), Miller adds. Now you report DVT using 453.8 (Other venous embolism and thrombosis; of other specified veins). For 2005, ICD-9 supplies three new, more-precise codes, which you should apply according to the area of the leg affected: