Neurology & Pain Management Coding Alert

Come Oct. 1, you're going to have to apply a different diagnosis code for stroke patients. Now you report stroke or cerebrovascular accident (CVA) using ICD-9 code 436 (Acute, but ill-defined, cerebrovascular disease), but for the coming year, beginning in October you should instead choose existing code 434.91 (Cerebral artery occlusion, unspecified; with cerebral infarction) to describe this condition.

"Code 436 is a somewhat vague code that is not always included on Medicare coverage policies for CT/MRI of the brain," says Jackie Miller, MA, CPC, senior consultant at Coding Strategies Inc., a healthcare reimbursement consulting firm in Dallas, Ga. In contrast, she continues, "434.91 is a much more specific code that is more likely to be covered for imaging of the head.

"For instance, I was looking over the Empire Medicare hospital coverage policy for MRA of the head and neck [for example, 70544, Magnetic resonance angiography, head; without contrast materials(s)], and these exams are not covered for 436, but are covered for 434.91," Miller says.

Neurologists might order MRAs and other diagnostic tests for stroke patients, and you should be sure to use 434.91, beginning Oct. 1, to indicate a stroke or CVA diagnosis. And when the neurologist treats stroke-related neurological conditions, you may refer to 434.91 as a secondary (underlying) diagnosis.

For a complete list of index revisions to ICD-9, visit the Center for Disease Control's Web site at www.cdc.gov/nchs/data/icd9/icdidx_addenda05.pdf.