Home Health ICD-9/ICD-10 Alert

New 5-digit code offers more-specific alternative when 'CVA'is backed by detailed documentation

Warning: You may be reporting stroke diagnoses differently in 2005 than in the past. According to the ICD-9-CM Index Addenda on the National Center for Health Statistics Web site, changes have been made to the index entries for "accident, cerebrovascular" and "stroke," says Jackie Miller, RHIA, CPC, senior consultant at Per-Se Technologies, a medical reimbursement consulting firm in Atlanta.

The diagnoses of "stroke" and "CVA" are now reported with 436 (Acute, but ill defined, cerebrovascular disease), Miller says. However, as of Oct. 1, 434.91 (Cerebral artery occlusion, unspecified, with cerebral infarction) is a more specific option, if the necessary documentation is included in the medical record.

Code 436 has not gone away, and will probably be used equally as much, says Lynda Dilts-Benson, RN, CCM, CRRN, CRNAC, LHRM, HCS-D, with Reingruber & Company in St. Petersburg, Fla. "They just gave you a more specific way to code stroke," but only if the patient had an MRI or a CT scan to prove the occlusion and infarction. It's great that 434.91 is an option, but physicians will probably continue to state "CVA" in the documentation, in which case you will continue to report 436.

To see the changes, scan the Index Addenda (the annual changes are officially referred to as "Addenda") at http://www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/ftpicd9.htm#guidelines.