Clinton, TN
Best answers
I have looked for articles for CVA and rules for coding in the doctors office but am unable to locate anything. The doctors just write CVA on the fee ticket and that is all. I guess they think that I can just pull something out of thin air :p . Are there rules for coding in the doctors office? For instance the doctor wrote elev LFT, CRF, and CVA. So I would not think that 438 would really be great. The other option is to use history of code which would be fine with me, but I just want to make sure that is correct and get others input on it.

Thanks in advance.
I code for a radiology office. If you look up accident, then cerebrovascular there will be a list of codes for you depending on whether it is acute, old, impending, etc. If it is an acute CVA 434.91 would be the correct code. You mentioned 438 though, so that would be used for any late effects of a previous CVA. Has the patient been seen before for this diagnosis? If not, I would consider coding 434.91. Can you review the doctor's notes from the visit to get more information?
I agree with 434.91, also.

Report a CVA or stroke accurately.
The terms stroke and cerebrovascular accident (CVA) are often used interchangeably for cerebral infarct. CVA, stroke, and infarct are all indexed in ICD-9-CM to 434.91, Cerebral artery occlusion, unspecified, with cerebral infarction. Do not report a CVA or stroke with 436, Acute but ill-defined cerebrovascular disease. A postoperative CVA is reported with 997.02, Iatrogenic cerebrovascular infarction or hemorrhage.