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May 25th, 2011 - Katieriley 1 

CVA coded with benign HTN

We have come across where RN's are using Benign HTN with CVA codes. Should this be done? Shouldn't it be another code for HTN since Benign is mild.

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May 25th, 2011 - nmaguire   2,606 

re: CVA coded with benign HTN

And the documentation supports? This is the doctors diagnosis, if any question on severity, query the physician. If documentation supports "benign" hypertension, then that is the code assigned. What is the primary diagnosis code in the case of CVA?

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May 25th, 2011 - Katieriley 1 

re: CVA coded with benign HTN

438.19 Other speech and language deficits plus 438.89 other LE of CVA are first 2 Dx, than in the top 6 they have 401.1

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May 25th, 2011 - nmaguire   2,606 

re: CVA coded with benign HTN

So, you are seeing the patient for the residual effects of a CVA. Again, the medical record would give medical necessity for the encounter and the primary diagnosis is the reason for the visit. Secondary diagnosis, such as HTN can be added as documented. The coding professional cannot diagnose but can question any gray areas. Code 401.1 must state benign hypertension in the medical record. At least ICD-10 will not have this issue because HTN (essential, benign, malignant, etc) is one code I10 Essential (primary) hypertension..

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May 25th, 2011 - jschmutz   323 

re: CVA coded with benign HTN

438.xx are not CVA diagnoses. These are late effect diagnoses due to cerebrovascular disease. It would be odd to report both 438.19 and 438.89 together (redundant), plus with 438.89 you need an additional code code to identify what the late effect is (not another 438 code).  A person can have a stroke or a CVA regardless of whether they have benign or malignant hypertension.  


 


Per the ICD-9 Guidelines: First assign codes from 430-438, Cerebrovascular disease, then the appropriate hypertension code from categories 401-405....Assign appropriate code from categories 401-405. This diagnostic statement usually refers to an existing state of hypertension under control by therapy....Uncontrolled hypertension may refer to untreated hypertension or hypertension not responding to current therapeutic regimen. In either case, assign the appropriate code from categories 401-405 to designate the stage and type of hypertension. Code to the type of hypertension.


 


 


A cerebral vascular accident (CVA), commonly referred to as a stroke, is a general term used to describe any disturbance in cerebral circulation that results in ischemia and anoxia.  A stroke occurs when blood vessels carrying oxygen to a part of the brain suddenly burst or become blocked. When blood fails to get through to the affected parts of the brain, the oxygen supply is cut off and brain cells begin to die. Strokes fall into several major categories, based on whether the disrupted blood supply is caused by a blocked blood vessel (ischemic stroke) or a hemorrhage. 


 


Nonhemorrhagic Stroke


Thrombosis. A blood clot (thrombus) forms inside an artery in the brain, blocking blood flow. The clot may occur in the cerebral, carotid or vertebral arteries.


Embolism. A clot, originating somewhere other than the brain, breaks loose and is carried by the blood stream to the brain. The clot reaches a point where it can go no further and plugs the vessel, cutting off the blood supply.


 


Hemorrhagic Stroke


Subarachnoid hemorrhage. The bleeding occurs in the space between the brain and the skull.


Intracerebral hemorrhage. A defective artery within the brain bursts, flooding the surrounding brain tissue with blood.


Hemorrhagic strokes are frequently caused by aneurysms. Another cause of hemorrhagic strokes is an arteriovenous malformation (AVM), which is a cluster of abnormal blood vessels.


 


Codes from categories 430-434 should be used when coding the initial episode of care for an acute cerebral hemorrhage, occlusion, thrombosis, infarction or stroke.


 


Once a patient has completed the initial treatment or is discharged from care, codes from category 438, Late effects of cerebrovascular disease should be assigned to identify the residual neurologic deficits or late effects of cerebrovascular disease.


Category 438 is used to identify residuals or late effects of cerebrovascular disease when a patient is seen or admitted at a later date. These late effects include neurological deficits that persist after the initial onset of the cerebrovascular event.


 


For example: A patient is seen with hemiplegia on the dominant side due to an old CVA. Code 438.21, Late effects of cerebrovascular disease, hemiplegia affecting dominant side is assigned.


Codes from category 438 may be assigned as the principal diagnosis when the reason for admission is to deal with the late effect. However, if the admission is for rehabilitation a code from category V57, Care involving use of rehabilitation procedures is assigned as the principal diagnosis with an additional code from category 438.


For example: A patient is admitted for rehabilitation consisting of speech therapy, occupational therapy and physical therapy for residual aphasia and hemiplegia following a CVA. In this instance code V57.89, Other specified rehabilitation procedure, is assigned as the principal diagnosis. Codes 438.11, Late effects of cerebrovascular disease, Aphasia, and 438.20, Late effects of cerebrovascular disease, Hemiplegia affecting unspecified side are assigned as additional diagnoses.


 


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438.xx are not CVA diagnoses. These are late effect diagnoses due to cerebrovascular disease. It would be odd to report both 438.19 and 438.89 together (redundant), plus with 438.89 you need a symptom to code to identify what the late effect is. A person can have a stroke or a CVA regardless of whether they have benigh or malignant hypertension.

Per the ICD-9 Guidelines: First assign codes from 430-438, Cerebrovascular disease, then the appropriate hypertension code from categories 401-405....Assign appropriate code from categories 401-405. This diagnostic statement usually refers to an existing state of hypertension under control by therapy....Uncontrolled hypertension may refer to untreated hypertension or hypertension not responding to current therapeutic regimen. In either case, assign the appropriate code from categories 401-405 to designate the stage and type of hypertension. Code to the type of hypertension.


A cerebral vascular accident (CVA), commonly referred to as a stroke, is a general term used to describe any disturbance in cerebral circulation that results in ischemia and anoxia. A stroke occurs when blood vessels carrying oxygen to a part of the brain suddenly burst or become blocked. When blood fails to get through to the affected parts of the brain, the oxygen supply is cut off and brain cells begin to die. Strokes fall into several major categories, based on whether the disrupted blood supply is caused by a blocked blood vessel (ischemic stroke) or a hemorrhage.

Nonhemorrhagic Stroke
Thrombosis. A blood clot (thrombus) forms inside an artery in the brain, blocking blood flow. The clot may occur in the cerebral, carotid or vertebral arteries.
Embolism. A clot, originating somewhere other than the brain, breaks loose and is carried by the blood stream to the brain. The clot reaches a point where it can go no further and plugs the vessel, cutting off the blood supply.

Hemorrhagic Stroke
Subarachnoid hemorrhage. The bleeding occurs in the space between the brain and the skull.
Intracerebral hemorrhage. A defective artery within the brain bursts, flooding the surrounding brain tissue with blood.
Hemorrhagic strokes are frequently caused by aneurysms. Another cause of hemorrhagic strokes is an arteriovenous malformation (AVM), which is a cluster of abnormal blood vessels.

Codes from categories 430-434 should be used when coding the initial episode of care for an acute cerebral hemorrhage, occlusion, thrombosis, infarction or stroke.

Once a patient has completed the initial treatment or is discharged from care, codes from category 438, Late effects of cerebrovascular disease should be assigned to identify the residual neurologic deficits or late effects of cerebrovascular disease.
Category 438 is used to identify residuals or late effects of cerebrovascular disease when a patient is seen or admitted at a later date. These late effects include neurological deficits that persist after the initial onset of the cerebrovascular event.

For example: A patient is seen with hemiplegia on the dominant side due to an old CVA. Code 438.21, Late effects of cerebrovascular disease, hemiplegia affecting dominant side is assigned.
Codes from category 438 may be assigned as the principal diagnosis when the reason for admission is to deal with the late effect. However, if the admission is for rehabilitation a code from category V57, Care involving use of rehabilitation procedures is assigned as the principal diagnosis with an additional code from category 438.
For example: A patient is admitted for rehabilitation consisting of speech therapy, occupational therapy and physical therapy for residual aphasia and hemiplegia following a CVA. In this instance code V57.89, Other specified rehabilitation procedure, is assigned as the principal diagnosis. Codes 438.11, Late effects of cerebrovascular disease, Aphasia, and 438.20, Late effects of cerebrovascular disease, Hemiplegia affecting unspecified side are assigned as additional diagnoses.

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