Acute stroke vs. History of stroke with residual deficits

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Would someone clarify for me, and if possible provide supporting documentation, how to code acute strokes with deficits?

I am specifically looking for information on physician coding (not facility) of patients that have been admitted to the hospital. We use a 3M encoder and when a patient comes in with, for example, an acute stroke with facial droop, and left-sided weakness, I've been coding I63.9, R29.810, and G81.94. However, an auditor recently told me that I should be coding this as I63.9, I69.354, and I69.992. 3M leads me to the first set of diagnosis codes.

It's my understanding the I69 codes are for residual deficits of an acute stroke, although these residual deficits can be present at the onset of symptoms. Given that I'm coding for a physician who often times will only see the patient once in consultation, how do we know these deficits are going to be residual? Also, are there some guidelines as to when the acute phase of a stroke is over? Is it at discharge or ??

Thanks in advance!
 

foxparty

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Hi Stacy

I'm also looking to find out if the I69.xxx codes are to be used with a current CVA.
I agree with using the G codes based on the coding clinic explanation of how to code weakness and hemiplegia with a current stroke.
But did you find any further information?
 
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Unfortunately, I have not found anything out about this topic. I’m going to try to do some more research on it and if I do find an answer, I’ll let you know!
 
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I will toss in my logic as this was something a colleague and I considered in 2017. I'll simply reference the 2020 ICD-10-CM guide lines and code descriptions.

Consider the I63 Excludes 2 note for "Sequelae of cerebral infarction (I69.3-)". This makes some sense if I63 codes are for the acute phase of the CVA. Consider in the Guidelines Section I, B, 10. Sequela (late effects) and see that the sequela is the residual effect after the acute phase. Then recognize I69 is the sequela of cerebrovascular disease.

I63 codes for acute phase and I69.3 is after the acute phase. Likewise I61 (acute) and I69.1 (after acute), and I62 compared to I69.2.

General rule we go by is a new acute phase is carried throughout a hospital stay, and once discharged, further references to that CVA occurrence will be considered after the acute phase. Therefore signs/symptoms or conditions are indicated during the acute phase such as the G81.9- codes. And follow-up office visits should not be I63.9 and G81.91. I69.351 would be the appropriate code for that follow-up.

Lastly why the "Excludes 2" under I63 rather than Excludes 1? The patient above had a CVA with residual right side hemiparesis, and then later had another acute CVA. You then would code both the appropriate I63 code and the I69.351 for the sequela of the earlier stroke. Note you can not code both the I69.35- sequela code with the G81.91 code so if the right hemiparesis is noted to be worse than usual I trend to something like M62.81.
 
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