Correctly Coding Cerebrovascular Disease – April 2022 Coding Tip

Gentle Reminder: Per AHA Coding Handbook it is appropriate to utilize reports to provide greater specificity of the anatomical site as documented by the provider. “Coding professionals may need to review an X-ray report to identify the location of a fracture, or an imaging report, such as a magnetic resonance (MRI) study, to determine the location of the infarction or stroke in a patient diagnosed with a cerebral infarction or hemorrhagic stroke.”

ICD-10 Code CategoryICD-10 Description
I60-I62Non-traumatic intracranial hemorrhage
I63Cerebral infarctions
I65-I66Occlusion/stenosis of cerebral and precerebral vessels without infarction
I67-I68Other cerebrovascular diseases
I69Sequelae of cerebrovascular disease (late effect)
  • Code category I60-I62 specifies the location or source of a hemorrhage as well as its laterality
  • Code category I63 specifies the following:
    • Cause of the ischemic stroke
    • Specific location and laterality of the occlusion
  • Code category I65-I66 requires the coder to be able to determine whether an occlusion or stenosis involves the precerebral arteries or the cerebral arteries
    • Precerebral arteries include:
      • Vertebral artery
      • Basilar Artery
      • Carotid Artery
    • Cerebral arteries include:
      • Anterior cerebral artery
      • Middle cerebral artery
      • Posterior cerebral artery
  • Code category I67-I68 specifies other cerebrovascular diseases and cerebrovascular disorders in diseases classified elsewhere
  • Code category I69 (Sequelae of cerebrovascular disease) specifies the type of stroke that caused the sequelae (late effect) as well as the residual condition itself. Codes from Category I69 also identify whether the dominant or non-dominant side is affected

Coding guidelines state that the late effects (sequelae) caused by a stroke may be present from the onset of a stroke or arise at ANY time after the onset of the stroke.

If a patient is NOT EXPERIENCING A CURRENT CEREBROVASCULAR ACCIDENT (CVA) and has no residual or late effect from a previous CVA, Z86.73 (personal history of transient ischemic attack, and cerebral infarction without residual deficits) should be assigned. A patient experiencing no residual effects from a previous stroke should NEVER be assigned a current stroke code.

In order to accurately code sequelae (late effect) of cerebrovascular disease, the side of the body affected should be clearly documented in the medical record.

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