Watch terms and deficits to choose legitimate codes. Updated ICD-9 guidelines went into effect October 1, 2010, with three section changes affecting neurology coders. Not all 2011 ICD-9-CM books will include the updated guidelines because the books went to printers before the updated guidelines became available. Read on for the basic information your practice needs to know, however, then check out the full guidelines at www.cdc.gov/nchs/data/icd9/icdguide10.pdf. Check Your Terminology Patients -- and practitioners -- sometimes use the terms "stroke" and "CVA" (cerebrovascular accident) interchangeably to refer to a cerebral infarction. The terms "stroke," "CVA," and "cerebral infarction NOS" each fall under diagnosis 434.91 (Cerebral artery occlusion, unspecified; with cerebral infarction). The updated guidelines add, "Additional code(s) should be assigned for any neurological deficits with the acute CVA, regardless of whether or not the neurologic defect resolves prior to discharge." Example: Don't Mix Late Effects With Neurological Deficits Diagnoses under ICD-9's category 438 deal with late effects of cardiovascular disease. Definition: Hammer says. "The residual may be apparent early, such as in cerebrovascular accident cases, or if may occur months or years later, such as those due to a previous injury." According to current ICD-9 guidelines, you turn to 438.xx when indicating conditions in categories 430-437 as the cases of late effects. These late effects include neurological deficits that persist after the initial onset of conditions in categories 430-437, such as speech and language deficits (438.1x), dysphagia (438.82), or vertigo (438.85). Change: Example: Remember Diagnosis Signals Disease Guidelines under Section 1 C.18.d.3 differentiate status and history diagnosis codes. The guideline update clarifies what status codes represent: "Status codes indicate that a patient is a carrier of a disease, has the sequelae or residual of a past disease or condition, or has another factor influencing a person's health status." A status code (such as V58.61, Long-term use of anticoagulants) informs healthcare providers and insurers of the patient's condition, and might affect the course of treatment and its outcome. Reporting a personal history code (such as V12.41, Personal history of benign neoplasm of the brain) explains a patient's past medical condition that no longer exists and is not receiving any treatment. The code also indicates that the patient has the potential for recurrence, however, and therefore might require continued monitoring. Final note: ICD-9 codes, as they may help 'explain' the medical necessity for diagnostic tests, procedures, etc.," Hammer adds.