Radiology Coding Alert

Question: How do you know when to include chronic cerebral ischemic disease as a diagnosis on a computed tomography (CT) or magnetic resonance imaging (MRI) scan of the brain?

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Answer: Depending on the age of the patient, you’ll find some degree of chronic cerebral ischemic disease on most CT or MRI scans of the brain. While it’s a common diagnosis for most older patients, the reason for the visit and the radiologist’s notes in the impression will be the determining factors as to whether you include it as a diagnosis.

Under most circumstances, the chronic cerebral ischemic disease is an incidental finding. This condition is primarily asymptomatic and will not typically contribute to the patient’s presenting symptoms or conditions. Unless the clinical indication documents chronic ischemic disease as the reason for the scan, or the radiologist notes that the chronic ischemic disease is abnormal or extensive for the patient’s age, you should not report code I67.82 (Cerebral ischemia).

For instance, consider a scenario in which a 68-year-old individual receives an MRI scan of the brain for dizziness and the impression yields no results outside of chronic cerebral ischemic disease. In this case, you’ll report code R42 (Dizziness and giddiness) as the primary diagnosis. You will not report I67.82 as a secondary diagnosis.