The countdown clock for the Patient-Driven Payment Model (PDPM) is ticking, with Oct. 1, 2019, implementation not far away. Today’s post on cerebral embolism coding continues our blog series on important skilled nursing facility (SNF) diagnoses to help MDS teams be ready for the big change — and the increased focus on the ICD-10-CM code set.
Read on to learn both the major codes for cerebral embolism without cerebral infarction and the symptoms you’re likely to see in the documentation based on the embolism location. And to ensure your skills are as sharp as they can be, don’t miss our previous posts on SNF ICD-10-CM coding:
Pinpointing the artery affected by the embolism is essential for accurate and complete diagnosis coding. If you need additional motivation to code correctly, remember it’s important both because it helps researchers who use ICD-10-CM data and because payers may check to be sure diagnoses match and support medical necessity (and therefore payment) for the procedures performed.
For cerebral embolism, you’ll turn to I66.- (Occlusion and stenosis of cerebral arteries, not resulting in cerebral infarction). A note under this code in the ICD-10-CM code set specifies that the category includes embolism of cerebral artery, as well as narrowing, partial or complete obstruction, and thrombosis of cerebral artery. But don’t use codes from category I66.- when cerebral infarction codes I63.3- to I63.5- are appropriate for your resident’s case.
To allow distinct reporting of middle, anterior, and posterior cerebral artery embolism, category I66.- further breaks down into I66.0- (Occlusion and stenosis of middle cerebral artery), I66.1- (Occlusion and stenosis of anterior cerebral artery), and I66.2- (Occlusion and stenosis of posterior cerebral artery).
But ICD-10-CM isn’t done yet. This code set, known for its high specificity, requires you to add one more character to each code for it to be complete and reportable. For our target codes, the fifth character allows you to identify whether the artery is right, left, bilateral, or unspecified.
For example: ICD-10-CM includes I66.01 (Occlusion and stenosis of right middle cerebral artery), I66.12 (Occlusion and stenosis of left anterior cerebral artery), I66.23 (Occlusion and stenosis of bilateral posterior cerebral arteries), and I66.29 (Occlusion and stenosis of unspecified posterior cerebral artery).
This anatomic information is likely already in your documentation, but you’ll want to be sure you have easy access to details like that for faster coding when you need it.
The symptoms of cerebral embolism may vary by where the embolism occurs. Refresh your knowledge with these quick pointers.
Middle: If documentation confirms middle cerebral embolism (I66.0-), symptoms you may see documented include hemiplegia (paralysis on one side of the body) and fixation of the eyes. Typically, the hemiplegia will be on the side opposite the embolism.
Anterior: When the resident’s diagnosis is anterior cerebral artery embolism (I66.1-), symptoms noted may include apraxia (inability to perform familiar movements), anosmia (loss of sense of smell), gaze toward the side the embolism is on, urinary incontinence, or grasping reflex. That’s not a complete list, but it includes some of the more typical signs that an embolism affected the frontal lobe.
Posterior: A clinical note confirming posterior cerebral embolism (I66.2-) may also reference gait imbalance, hand-eye coordination issues, bumping into obstacles accompanied by falls, vision loss (such as not being able to see half of a printed page), confusion, and dizziness.
Lesson learned: To prepare for accurate and efficient application of embolism codes under ICD-10-CM category I66.-, familiarize yourself with the conditions involved and know where to find documentation about the location, referencing middle, anterior, or posterior, as well as right, left, or bilateral.
Contributing editor: Rachel Dorrell
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