Home Health ICD-9/ICD-10 Alert

Question: Our patient is experiencing blurred vision as a late effect of stroke. How should we code for this?

Arizona Subscriber

Answer: Ordinarily, when you’re coding for a late effect, you’ll need to report two codes. List the code for the presenting problem first, followed by the late effect code.

But with CVA late effects, you’ll most often need only one code. Many codes in the 438.x (Late effects of cerebrovascular disease) category combine the presenting problem with the late effect in one code, known as a combination code.

For example: 438.22 (Late effect cerebrovascular disease, hemiplegia, non-dominant side).

However, there are some CVA combination codes that will require you to report additional information to fully describe a patient’s condition. You’ll notice that some of the combination codes in the 438.xx category instruct you to add a second code.

When you see a “use additional code” note in the 438.x section of your coding manual, you will sequence your codes in reverse order than you would for other late effects. In other words, you’ll code the late effect code first, followed by the residual or presenting problem.

This is because the coding guideline for combination codes states, “When the combination code lacks necessary specificity in describing the manifestation or complication, an additional code should be used as a secondary code.” That means that you should add the code that provides more specificity about the nature of the residual.

This is true in your patient’s situation. When coding for a vision disturbance as a late effect of stroke, you’ll need to list an additional code to describe the type of disturbance along with the combination code 438.7 (Late effects of cerebrovascular disease; disturbances of vision). Since your patient is experiencing blurred vision as a late effect of stroke, you would list 438.7 followed by 368.8 (Blurred vision, NOS).

ICD-10: If you were coding for this patient in ICD-10, you would list I69.398 (Other sequelae of cerebral infarction) and H53.8 (Other visual disturbances).

You’ll use I69.398 to identify both sensation and visual disturbances as sequela of strokes. The “use additional code” note following I69.398 reminds you to provide more information about the specific sequela your patient is experiencing. In this case, you’ll code for the blurred vision with H53.8.