Home Health ICD-9/ICD-10 Alert

Question: I have heard that we are not supposed to use transient ischemic attack (TIA) as a diagnosis in home health. Can you explain why that might be? If a TIA diagnosis is off-limits, how would I code for a patient who is receiving skilled nursing after a recent TIA?

Ohio Subscriber

Answer: There is no prohibition against coding TIAs in home health. Providing care to a person who has had a TIA in the form of teaching and observation and assessment meets the medical-necessity criteria.

Of the people who've had one or more TIAs, more than a third will later have a stroke, the American Heart Association says.

The confusion regarding coding TIAs in home care may come from the idea that since the TIA no longer exists, you shouldn't code for it. However, TIAs are similar to congestive heart failure (CHF) -- you don't get rid of it and it is likely to happen again.

The TIA diagnosis, 435.9 (Unspecified transient cerebral ischemia), is a case mix diagnosis. When deciding whether to code for a TIA, you should consider how long it's appropriate to keep the TIA as the primary diagnosis.

Observation and assessment is only considered medically necessary as long as there is a probability or possibility of a fluctuating condition. The medical necessity of teaching depends on several factors. So, although there is nothing wrong with coding TIAs in home care and nothing wrong with coding them as primary when they are the focus of care, you should keep an eye on the documentation to ensure that it supports the use of the diagnosis as primary.

Here are some more TIA facts from the American Heart Association:

• TIAs occur when a blood clot temporarily clogs an artery, and part of the brain doesn't get the blood it needs.

• The symptoms occur rapidly and last a relatively short time. Most TIAs last less than five minutes. The average is about a minute.

• Unlike stroke, when a TIA is over, there's no injury to the brain.

• A person who's had one or more TIAs is more likely to have a stroke than someone of the same age and sex who hasn't.

• TIAs are important in predicting if a stroke will occur rather than when one will happen.

• TIAs can occur days, weeks or even months before a major stroke.

• The stroke occurs within one year of the TIA in about half the cases