Cerebrovsacular Accident - CVA or Stroke

Due to CVA the affected area of the brain is unable to function, leading to inability to move one or more limbs on one side of the body, inability to understand or formulate speech or inability to see one side of the visual field.

CVA should be differentiated from transient ischemic attack, which is a related syndrome of stroke symptoms that resolve completely within 24 hours.

CVA or Stroke or cerebrovascular accident: ICD-10 I61.-I64.
ICD-9 434.91

ICD-9-CM states that CVA should be coded as long as the patient is receiving treatment and till the patient is discharged. Once the patient is discharged and for further visits late effect codes of CVA (438 category) should be used.

The late effects of CVA are neurological deficits that persist after initial onset of CVA or may arise at any time later. Some of these condition are

aphasia (inability to speak)
apraxia (altered voluntary movements)
visual field defect
memory deficits or cognitive deficits (involvement of temporal lobe)
hemiplegia or hemiparesis

Although aphasia, apraxia, cognitive deficits, hemeplegia, or ataxia are not coded at the time of admission when the patient is diagnosed with CVA, but when the patient presents with these conditions a later date then a code from category 438 should be used to indicate that these are late effects of CVA.

ICD-9-CM proveides a V code V12.54 to indicate history of CVA. Codes from category 438 and CVA should not be assigned at the same visit of date either of these shluld be assigned.

Codes from category 438 can be assigned together with codes from 430-437 when a patient has current CVA and deficits from an old CVA.

In practical cases physicians do not document any relationship between neurological deficits and history CVA in the medical records. So when a patent has hemeplagia and also has a history of CVA codes from 438 catetogy i.e 438.20 are assigned instead of coding history of CVA (V12.54) and hemeplagia (368.10)seperately. The same rule applies to other neurological deficitis such as ataxia, aphasia, cognitive deficits, dysphagia.

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