434.91 – Stroke – Hemorrhage or Both?

When using 434.91 make sure you take all of the specifics into account. When a doctor says that a patient has had a stroke make sure that you know all of the details of the situation or else some procedures can be hard to justify and therefore your medical billing reimbursement may be denied.

In the past for diagnosis of a stroke the ICD-9 index listed 436, which is acute but ill defined cerebrovascular disease, as the code to use. Now the index has code 434.91 as the code to use. This is cerebral artery occlusion, unspecified with cerebral infarction. The new ICD-9 index automatically translates a doctors diagnosis of a cerebrovascular accident to an occlusion with an infarction.

This new listing is good news for you in that you might now get renumerated for services that were not covered in the past for patients of stroke. This is obviously good news and something that you will want to make sure that you are on top of.

Keep Documenting those Details

Consultant Sandy Nicholson with Pershing Yoakley & Associates in Atlanta, states that you should still make sure that physicians write down precise diagnoses. As of right now physicians can write down “stroke” without going into greater detail and you must discourage that. This means that you could be missing out on the diagnostic details that justify the procedures the doctor performed and therefore missing payment.

An example of this would be where the doctor doesn’t note a cerebral hemorrhage with a stroke, which would understate the seriousness of the patient’s condition. This is vital information for other providers so that they can realize how to treat the patient so not to kill him or her. Embolic strokes have 1/5 the death rate of hemorrhagic strokes and if there is nothing saying a patient has a hemorrhage and they are given coumadin or aspirin it could kill them.

The coder will use ICD-9 code 431 for Intracerebral hemorrhage if the doctor indicates that the patient has had a hemorrhage. There is a difference in what procedures Medicare will cover for differences in strokes. For a stroke without hemorrhage Medicare will not cover surgical or transcatheter interventions. So making sure that the diagnosis is specific and correct is very important.

View all Articles by: Melissa Clark, CCS-P