Home Health ICD-9/ICD-10 Alert

Code acute CVA with 434.91

If you're listing 436 without any billed therapies for your acute CVA or stroke patients, you're risking denials.

Watch for: Regional home health intermediary Cahaba GBA warns it will review claims that list 436 (Acute, but ill-defined, cerebrovascular disease), according to a July 26 Web site posting. "The documentation should describe the patient's chief reason for home care. The primary diagnosis for an episode of home health care is determined by deciding which diagnosis is most related to the plan of care," Cahaba states in its widespread edit provider notification.

Retire 436 for Strokes

For some coders, using 436 to indicate a stroke is a tough habit to break. As of Oct. 1, 2004, 436 specifically excludes strokes. "I have a hunch that many of the agencies that are 'caught' with this problem are not keeping up with coding rules and are using 436 as acute CVA," says Grand Rapids, MI-based consultant Arlene Maxim with Healthcare Management Consultants.

Best practice: Be as specific as possible when you code and avoid codes that describe a condition as ill defined. "Code 436 is now defined as 'Acute, ill defined cardiovascular disease.' Any time you have something 'ill defined' in a diagnosis, it is likely to be scrutinized," cautions Maxim.

Instead: Use 434.91 (Cerebral artery occlusion, unspecified with cerebral infarction) to denote an acute CVA when you are not provided specific information as to the cause of the CVA, such as a hemorrhage or an specific notation of an embolus or thrombus occlusion.

But first make certain that the documentation supports the diagnosis as the primary reason for home health care and the need for skilled visits, advises Lynnette Ludwig, RN, BSN of Crawford County Home Health, Hospice & Public Health in Denison, IA. If nursing and therapies are being provided, then the acute CVA should be in M0230, experts advise.

Know When CVA is Primary

For better coding accuracy, know when to report CVA as primary and when to use a late effects code.

Some coders "tend to want to use a late effects code, and are always a little unsure about how 'acute' this acute CVA really is," says Ludwig.

Cahaba offers these guidelines for when to code a CVA as primary and when to use a late effects code:

Code CVA as primary:

• when a patient is in the initial course of treatment for a new stroke, or

•  while the patient continues to show improvement in response to home health services, provided the CVA continues to be the reason for skilled home care.

Code late effects as primary:

•  when a patient has been discharged and later readmitted for a stroke-related problem.