Leading Cause of Death in America – April 2021 Coding Tip

Medical claims denials in 2019 approached $9 billion.

The denial rate in 2020 increased by 23%.

Coding/billing errors accounted for approximately 15% of all denials. Specificity of coding was one of the reasons claims were denied.

In 2019, stroke was the leading cause of death and killed approximately 140,000 Americans.

Three Simple Questions to Ask When Coding Strokes:

1. Is the stroke acute, chronic, or history? Oftentimes strokes will be listed as a current diagnosis, but the provider is referring, instead, to a history of stroke. Review the chart for acute deficits, current treatment or evaluation, and if in doubt, query the physician. If a chronic stroke is documented, code either the sequela of the stroke or a history code.
2. Where is the site of the stroke? If the physician documents a stroke/infarction, radiology reports can be utilized to determine the site (1).
   1. Precerebral Artery (I63.00 to I63.29) – Vertebral, Basilar, Carotid
   2. Cerebral Artery (I63.30 to I63.59) – Middle, Anterior, Posterior, Cerebellar (MCA, ACA, PCA, Cerebellum)
   3. Central Venous (I63.6)
   4. Lacunar or Small Vessel (I63.81)
   5. Unspecified (I63.9)
3. What type of stroke did the patient have?
   1. Thrombosis
      1. Precerebral (I63.00 – I63.09)
      2. Cerebral (I63.30 – I63.39)
      3. Central Venous (I63.6)
   2. Embolism
      1. Precerebral (I63.10 – I63.19)
      2. Cerebral (I63.40 – I63.49)
   3. Unspecified Occlusion/Stenosis
      1. Precerebral (I63.20 – I63.29)
      2. Cerebral (I63.50 – I63.59)

1 See AHA Coding Clinic, Third Qtr 2014: Page5