A NEUROLOGIST’S GUIDE TO USING ICD-9-CM CODES FOR ...

APPENDIX A NEUROLOGIST'S GUIDE TO USING ICD-9-CM CODES FOR

CEREBROVASCULAR DISEASES

INTRODUCTION

ICD-9-CM codes for cerebrovascular diseases is not "user friendly". This presentation is designed to assist neurologists in choosing proper ICD-9-CM codes by using a cross-walk to more familiar terms. The user is strongly encouraged to re-refer to ICD-9-CM Volume 1 after choosing a code here to be sure there are no other instructions which would indicate using a different code for this situation.

THIS GUIDE HAS NOT BEEN OFFICIALLY ACCEPTED BY CMS OR THE NATIONAL CENTER FOR HEALTH STATISTICS. IT IS POSSIBLE THAT CERTAIN MEDICARE CARRIERS OR OTHER THIRD PARTY REVIEWERS MAY DISAGREE WITH THESE CODING CHOICES.

Acute Inpatient Coding: Use the appropriate acute stroke codes (see appendix 1). Add the manifestations if possible, or consider adding risk factors (if addressed).

Outpatient coding: If the patient is seeing you for the first time for a stroke as an outpatient, and your consultation or new visit centers on managing or working up the acute event, then use the acute stroke codes.

If, on the other hand, you are managing a stroke patient who has already had a workup and/or is being seen in followup of the acute event, then use the late effects codes (see appendices 2 & 3) if you are following the sequelae.

It is not unreasonable to use a risk factor code if that is what is addressed in the visit, but it is more likely that these will be used as secondary codes (if addressed in the visit).

Appendix 1

DIAGNOSIS

SUGGESTED ICD-9-CM CODE

Transient cerebral ischemia and related syndromes

(Note these are four digit codes)

Vertebral artery TIA or

435.1 Transient cerebral ischemia, Vertebral

syndrome

artery syndrome

Basilar artery TIA or syndrome 435.0 Transient cerebral ischemia, Basilar

artery syndrome

Vertebrobasilar (artery)TIA or 435.3 Transient cerebral ischemia,

syndrome

Vertebrobasilar artery syndrome

Carotid artery TIA or syndrome 435.8 Other specified transient cerebral

ischemia

TIA in any other

435.8 Other specified transient cerebral

cerebrovascular territory

ischemia

(Middle cerebral, Posterior

cerebral, Anterior cerebral, etc)

TIA without territory specified 435.9 Unspecified transient cerebral

ischemia

Amaurosis fugax

326.34 Retinal vascular occlusion, Transient

arterial occlusion

Transient global amnesia

437.7 Transient global amnesia

Occlusion or stenosis of precerebral (extracranial) arteries WITHOUT

infarction (stroke)

(Note these are five digit codes)

Basilar artery occlusion or

433.00 Occlusion and stenosis of

stenosis

precerebral arteries, Basilar artery, without

mention of infarction

Vertebral artery occlusion or 433.20 Occlusion and stenosis of

stenosis

precerebral arteries, Vertebral artery,

without mention of infarction

Carotid artery occlusion or

433.10 Occlusion and stenosis of

stenosis

precerebral arteries, Carotid artery, without

mention of infarction

Multiple and bilateral

433.30 Occlusion and stenosis of

precerebral (extracranial)

precerebral arteries, Multiple and bilateral

artery occlusion or stenosis arteries, without mention of infarction

Precerebral (extracranial)

433.90 Occlusion and stenosis of

artery occlusion or stenosis precerebral arteries, unspecified precerebral

without territory specified

artery, without mention of infarction

Occlusion or stenosis of precerebral (extracranial) arteries WITH infarction (stroke) (Note these are five digit codes)

Basilar artery occlusion or stenosis

Vertebral artery occlusion or stenosis

Carotid artery occlusion or stenosis

Multiple and bilateral precerebral artery occlusion or stenosis Precerebral artery occlusion or stenosis without territory specified

433.01 Occlusion and stenosis of precerebral arteries, Basilar artery, with infarction 433.21 Occlusion and stenosis of precerebral arteries, Vertebral artery, with infarction 433.11 Occlusion and stenosis of precerebral arteries, Carotid artery, with infarction 433.31 Occlusion and stenosis of precerebral arteries, Multiple and bilateral arteries, with infarction 433.91 Occlusion and stenosis of precerebral arteries, unspecified precerebral artery, with infarction

Occlusion or stenosis of intracerebral arteries WITH infarction (stroke)

(Note these codes have five digits)

Middle cerebral artery

434.01 Occlusion of cerebral arteries,

infarction (stroke), thrombotic Cerebral thrombosis, with cerebral infarction

Middle cerebral artery

434.11 Occlusion of cerebral arteries,

infarction (stroke), embolic

Cerebral embolism, with cerebral infarction

Anterior cerebral artery

434.01 Occlusion of cerebral arteries,

infarction (stroke), thrombotic Cerebral thrombosis, with cerebral infarction

Anterior cerebral artery

434.11 Occlusion of cerebral arteries,

infarction (stroke), embolic

Cerebral embolism, with cerebral infarction

Posterior cerebral artery

434.01 Occlusion of cerebral arteries,

infarction (stroke), thrombotic Cerebral thrombosis, with cerebral infarction

Posterior cerebral artery

434.11 Occlusion of cerebral arteries,

infarction (stroke), embolic

Cerebral embolism, with cerebral infarction

Any other intracerebral artery 434.01 Occlusion of cerebral arteries,

infarction (stroke), thrombotic Cerebral thrombosis, with cerebral infarction

Any other intracerebral artery 434.11 Occlusion of cerebral arteries,

infarction (stroke), embolic

Cerebral embolism, with cerebral infarction

Cerebral thrombosis (no artery 434.01 Occlusion of cerebral arteries,

mentioned)

Cerebral thrombosis, with cerebral infarction

Cerebral embolism, (no artery 434.11 Occlusion of cerebral arteries,

mentioned)

Cerebral embolism, with cerebral infarction

Lacunar infarction (stroke)

434.91 Cerebral artery occlusion,

unspecified, with cerebral infarction

Cerebral infarction (stroke)

434.91 Cerebral artery occlusion,

with no vascular territory

unspecified, with cerebral infarction

specified

NOTE THAT THE "DEFAULT" CODE FOR ISCHEMIC STROKE IS:

434.91 Cerebral artery occlusion, unspecified, with cerebral infarction If the only term documented is "Stroke", then use this code. Use this code when the vascular territory is unknown. Because of the lack of specificity of this code please "upgrade" to a more specific code as soon as the vascular territory and mechanism of stroke are known.

Hemorrhage (bleed) Nontraumatic subarachnoid hemorrhage Intracerebral (intraparenchymal) hemorrhage Intraventricular hemorrhage Nontraumatic subdural hemorrhage Nontraumatic extradural (epidural) hemorrhage "Intracranial" hemorrhage without further site or type specification

430 Subarachnoid hemorrhage 431 Intracerebral hemorrhage

431 Intracerebral hemorrhage 432.1 Subdural hemorrhage 432.0 Nontraumatic extradural hemorrhage 432.9 Unspecified intracranial hemorrhage

Other cerebrovascular diagnoses

Nonruptured cerebral

437.3 Cerebral aneurysm, nonruptured

aneurysm, any territory

Cerebral atherosclerosis

437.0 Cerebral atherosclerosis

(useful when attributing a

manifestation such as vascular

dementia)

Diffuse cerebral ischemia

437.1 Other generalized ischemic

(nonatherosclerotic)

cerebrovascular disease

Hypertensive encephalopathy 437.2 Hypertensive encephalopathy

Cerebral arteritis (vasculitis) 437.4 Cerebral arteritis

Add code for the primary disease if

present!

Moyamoya disease

437.5 Moyamoya disease

Venous sinus thrombosis

437.6 Nonpyogenic thrombosis of

(noninfectious)

intracranial venous sinus

Infectious (pyogenic) venous 325 Phlebitis and thrombophlebitis of

sinus phlebitis or

intracranial venous sinuses.

thrombophlebitis

Binswanger's disease

Use two codes:

437.1 Other generalized ischemic

cerebrovascular disease

290.12 Presenile dementia with delusional

features

Carotid artery dissection

443.21 Dissection of carotid artery

Vertebral artery dissection Dissection of other artery, or artery not named. Cerebral amyloid angiopathy

443.24 Dissection of vertebral artery 443.29 Dissection of other artery

437.8 Other and ill-defined cerebrovascular disease

Eponyms

The codes indicated for use here by the index of ICD-9-CM are not compatible

with the specificity of the vascular territory. Please strongly consider coding

the vascular territory of infarction instead!

Claude syndrome

352.6 Multiple cranial nerve palsies

Foville syndrome

344.89 Other specified paralytic syndrome

Wallenburg syndrome

436 Acute,, but ill-defined cerebrovascular

disease

Weber syndrome (Weber-

344.89 Other specified paralytic syndrome

Gubler) (Weber-Leyden)

Millard-Gubler

344.89 Other specified paralytic syndrome

Appendix 2: Example

Late effects codes are used to describe conditions that occur at any time after the acute event. Use them for inpatient or outpatient care subsequent to the initial inpatient admission or outpatient evaluation.

Example: Stroke: Patient is right handed admitted for left hemisphere stroke with aphasia

and flaccid right hemiparesis.

Code during the acute admission:

434.91 Cerebral artery occlusion, unspecified

342.01 Flaccid hemiplegia, affecting dominant side.

784.3

Aphasia

Code after the acute admission:

438.21 Late effects of cerebrovascular disease, Hemiplegia affecting

dominant side

438.11 Late effects of cerebrovascular disease, Aphasia

Appendix 3: Late Effects Codes

Cognitive defects Speech and language deficit, unspecified Aphasia Dysphasia Other speech and language deficits Hemiplegia/hemiparesis affecting

438.0 438.10 438.11 438.12 438.19 438.20

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