Question:
Anne:
How would you code a remote CVA? or a remote anything? I have one doctor who has written the following diagnoses for a nursing home patient: seizure, remote CVA, tremor, abnormal gait. We are a family practice & go to 10 nursing homes/assisted living facilities. They only bring back a code sheet with the patient names and codes (this is how the prior billing company showed them what to do) ... I've been trying to break this!!!!
Answer Thread:
Alicia Scott:
I found this on a message board from 11 months ago:
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.
Also this from www.scanhealth.com
Acute Condition Not Usually Treated in an Office Setting
Although patients occasionally present to the physician’s office with life threatening conditions, in
general patients are treated in a hospital setting. Remember that historical (“history of”) conditions are
not coded as if the patient has the condition currently. Physicians also cannot code “rule out” conditions.
ICD-9 436, 434.X – Acute ill defined cerebrovascular disease, CVAs
The description of ICD-9 436 changed in 2006, and it is no longer described as a CVA. It is now
described as “acute, ill defined cerebrovascular disease.” The cross referenced terms are apoplexy,
apoplectic attack, or cerebral seizure.
Both 436 and the CVA codes in 434.XX are acute conditions. The codes should only be used for
patients during the acute hospitalization/SNF stay for these conditions. After the patient is discharged
from the facility, the correct documentation and coding is “history of CVA.”
In chart review, we find that these codes are most often incorrectly used for patients with a history of a
CVA, sometimes a very remote history. The ICD-9 has separate diagnosis codes for history of CVA:
V12.59 – history of CVA (without sequelae)
438.XX—late effects of CVA
The progress note must indicate the late effect of the CVA, and its cause (e.g., L hemiparesis 2° to
CVA) in order to use the late effect codes.
You know you pt is not having a CVA now. There doesn't seem to be a late effect, paralysis of the CVA noted. Nothing stated is directly related per documentation. I would code Hx of a CVA. Remote is most likely referring to old. I am just guessing here. We need to ask Jane. This is right up her ally. I will send her an e-mail. Not sure if she has been in the forum for a bit because she is having shoulder surgery.
One thing is for sure you need to nip that documentation in the bud. They are cutting themselves short on money.
Anne:
Alicia,
This thank you is very delayed, but...thank you so much! A lot has been going on; and I just have not been able to get to the boards. I appreciate your help very, very much. The doctors are realizing they are cutting themselves short on money in a lot of areas, with different things that I am bringing to their attention.
Beginning Monday, I will now be over-seeing the office as well since the 'manager' decided that this Friday is her last day. ... I also need to map out a new study guideline for my CPC exam scheduled for May 3rd in Lincroft since the CCS is on hold indefinitely for now. UGH!!!!!!!!!
Stressed......Anne
Alicia Scott:
You can do it Anne! Slow and steady is what works best. When you have time keep us updated here.
Anne:
Alicia,
Much delayed in my update. I did attend the CCO webinar on Thursday, and thoroughly enjoyed it as always, thank you both again!
This weekend is my "study all weekend" as next Saturday, 5/3 is my CPC exam. I am on the Blitz videos all morning, re-reviewing the guidelines this weekend .. and each night this week-except Friday, I will do a quiz/test. I am unfortunately working each day from 8am - 5 or 9 pm as well as training everyone all over again, but that is all par for the course right now.
I have to thank everyone at CCO for their support.
Anne
Alicia Scott:
Thanks for the update. You are a great example of how to get through while working full-time.
Anne:
This may sound wrong to some, but proudly I will say (while looking upward to heaven
to my Grandfathers & Uncle) ... I'm a stubborn Pollack ..at times .... LOL there are times I just have to laugh at myself.
Alicia Scott:
I like that!
Anne:
How would you code a remote CVA? or a remote anything? I have one doctor who has written the following diagnoses for a nursing home patient: seizure, remote CVA, tremor, abnormal gait. We are a family practice & go to 10 nursing homes/assisted living facilities. They only bring back a code sheet with the patient names and codes (this is how the prior billing company showed them what to do) ... I've been trying to break this!!!!
Answer Thread:
Alicia Scott:
I found this on a message board from 11 months ago:
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.
Also this from www.scanhealth.com
Acute Condition Not Usually Treated in an Office Setting
Although patients occasionally present to the physician’s office with life threatening conditions, in
general patients are treated in a hospital setting. Remember that historical (“history of”) conditions are
not coded as if the patient has the condition currently. Physicians also cannot code “rule out” conditions.
ICD-9 436, 434.X – Acute ill defined cerebrovascular disease, CVAs
The description of ICD-9 436 changed in 2006, and it is no longer described as a CVA. It is now
described as “acute, ill defined cerebrovascular disease.” The cross referenced terms are apoplexy,
apoplectic attack, or cerebral seizure.
Both 436 and the CVA codes in 434.XX are acute conditions. The codes should only be used for
patients during the acute hospitalization/SNF stay for these conditions. After the patient is discharged
from the facility, the correct documentation and coding is “history of CVA.”
In chart review, we find that these codes are most often incorrectly used for patients with a history of a
CVA, sometimes a very remote history. The ICD-9 has separate diagnosis codes for history of CVA:
V12.59 – history of CVA (without sequelae)
438.XX—late effects of CVA
The progress note must indicate the late effect of the CVA, and its cause (e.g., L hemiparesis 2° to
CVA) in order to use the late effect codes.
You know you pt is not having a CVA now. There doesn't seem to be a late effect, paralysis of the CVA noted. Nothing stated is directly related per documentation. I would code Hx of a CVA. Remote is most likely referring to old. I am just guessing here. We need to ask Jane. This is right up her ally. I will send her an e-mail. Not sure if she has been in the forum for a bit because she is having shoulder surgery.
One thing is for sure you need to nip that documentation in the bud. They are cutting themselves short on money.
Anne:
Alicia,
This thank you is very delayed, but...thank you so much! A lot has been going on; and I just have not been able to get to the boards. I appreciate your help very, very much. The doctors are realizing they are cutting themselves short on money in a lot of areas, with different things that I am bringing to their attention.
Beginning Monday, I will now be over-seeing the office as well since the 'manager' decided that this Friday is her last day. ... I also need to map out a new study guideline for my CPC exam scheduled for May 3rd in Lincroft since the CCS is on hold indefinitely for now. UGH!!!!!!!!!
Stressed......Anne
Alicia Scott:
You can do it Anne! Slow and steady is what works best. When you have time keep us updated here.
Anne:
Alicia,
Much delayed in my update. I did attend the CCO webinar on Thursday, and thoroughly enjoyed it as always, thank you both again!
This weekend is my "study all weekend" as next Saturday, 5/3 is my CPC exam. I am on the Blitz videos all morning, re-reviewing the guidelines this weekend .. and each night this week-except Friday, I will do a quiz/test. I am unfortunately working each day from 8am - 5 or 9 pm as well as training everyone all over again, but that is all par for the course right now.
I have to thank everyone at CCO for their support.
Anne
Alicia Scott:
Thanks for the update. You are a great example of how to get through while working full-time.
Anne:
This may sound wrong to some, but proudly I will say (while looking upward to heaven
to my Grandfathers & Uncle) ... I'm a stubborn Pollack ..at times .... LOL there are times I just have to laugh at myself.Alicia Scott:
I like that!