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

Comments

MEDICARE PREVENTIVE SERVICES FROM MEDICARE LEARNING NETWORK

This is a link to further information on the Medicare Preventive Services. The layout of it reminds me of a bingo card! Medicare Learning Network is the educational arm of Centers for Medicare and Medicaid Service (CMS). Remember this is further information on different types of screenings available to Medicare beneficiaries. https://www.cms.gov/Medicare/ Prevention/PrevntionGenInfo/ medicare-preventive-services/ MPS-QuickReferenceChart-1. html#AWV Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations. The information presented herein is for general informational purposes only and is accurate as of the date of publication.

Table VI-4. Disease Hierarchies for the 2017 CMS-HCC Model

If the Disease Group is Listed in this column… …Then drop the Disease Group(s) listed in this column is found here : Announcement of Calendar Year (CY) 2017 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter Found at: https://www.cms.gov/Medicare/HealthPlans/MedicareAdvtgSpecRateStats/Downloads/Announcement2017.pdf P 87 If the Disease Group is Listed in this column… …Then drop the Disease Group(s) listed in this column Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations. The information presented herein is for general informational purposes only and is accurate as of the dat...

Signature requirements

The Medicare Program Integrity Manual contains the guidance around signature requirements. They are found in chapter 3. 3.3.2.4 - Signature Requirements This material was also covered in the Part AB November 2025 webinar by Noridian entitled: Signature Requirements Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations. The information presented herein is for general informational purposes only and is accurate as of the date of publication.

HCC Blog by Caridad

Search This Blog