Stroke and Transient ischemic attack (TIA)

Stroke and Transient ischemic attack (TIA)

To code an acute stroke, use 434.01, 434.11 or 434.91 (these are used at the time of the initial hospital admission or on initial diagnosis in a skilled nursing facility).

When the provider documents “Stroke” it is coded as 434.91; “TIA” is coded as 435.9

Past stroke or TIA with no residual deficits could appropriately be documented as “history of stroke” or “history of TIA” and code V12.54.

Past stroke or TIA with residual deficits would have two codes – one for history or and one for the late effects.  

Watch for the following:

Code 434.1 Occlusion of cerebral arteries with cerebral infarction should only be assigned for acute stroke, ie, first admission to hospital or the initial diagnosis at a skilled nursing facility.

Code 436 is used for apoplexy and cerebral seizures but not used to report acute stroke. [Definition of apoplexy is: A sudden loss of consciousness followed by paralysis, due to cerebral hemorrhage or blocking of an artery of the brain by an embolus or thrombus.  Stedman’s Medical Dictionary 21^st edition.]

Residual effects for a CVA should be coded from the ICD-9 category 438 – Late effects of cerebrovascular disease.

438.0 Cognitive deficits

438.1 Speech and language deficits

438.2 Hemiplegia/hemiparesis

438.3 Monoplegia of upper limb

438.4 Monoplegia of lower limb

438.5 Other paralytic syndrome

438.6 Alterations of sensations

438.7 Disturbances of vision

438.8 Other late effects of cerebrovascular disease