Do you know the difference between a CVA and TIA?
When coding cerebral vascular accidents (CVA) and transient ischemic attacks (TIA), it is important to know the difference between the 2 diagnoses as well as the different types of CVA.
While both a CVA and TIA are caused by blockages to the arteries of the brain, a CVA is a more serious condition and can cause permanent brain cell damage and lasting deficits. The deficits last longer than 24 hours. A TIA is a temporary condition and the normal function of the patient returns quickly with little or no damage to the brain cells. The deficits last less than 24 hours.
A CVA can be caused by an embolism, thrombus or hemorrhage of the brain. (the brain hemorrhage is non-traumatic. Traumatic brain hemorrhages are not CVAs). Documentation is key and the Provider may have to be queried to clarify the type or site of the CVA. The vessel involved may be cerebral or precerebral and it may be an occlusion, stenosis, embolism, thrombus or hemorrhage.
Sometimes a hemorrhagic conversion may occur after a CVA. This may be due to TPA therapy or a separate incident. In this case, both the CVA and the hemorrhage would be coded.
It is also important to code the deficits that are associated with the CVA. These deficits may resolve prior to the patient’s discharge, but still need to be included in the coding. Many common deficits are hemiplegia/hemiparesis, dysphagia, aphasia, facial weakness, or quadriplegia.
Some facilities include the NIHSS and GCS scores. These are stroke scale scores that can be coded from a clinician’s documentation who are not the Provider. Some GCS scores are CCs (complication or comorbidity) and so, may affect the DRG assignment. Check with your facility as to their coding policy on capturing these codes.
Some CVA patients are given TPA (tissue plasminogen activator). This is a “clot buster” that dissolves the blood clot responsible for the CVA. It is important to code this procedure since it affects the DRG. If the patient was given TPA at another facility within 24 hours of admit to a different facility, the code Z92.82 should be added. This code will also affect the DRG.
Some patients may have a thrombectomy performed. This is a procedure where the blood clot is removed via a percutaneous or open approach. A thrombectomy code will also affect the DRG, so it is important to include this PCS code.
So, in conclusion, when coding CVA/TIA, you will want to ask the following questions in order to have accurate and complete coding:
- Is this a documented CVA or TIA?
- What is the vessel involved? – it could be precerebral or cerebral.
- Was it a thrombus, embolism, occlusion/stenosis or hemorrhage? (remember traumatic injury is not a CVA)
- Were there deficits such as hemiparesis, aphasia, dysphagia, facial droop, monoplegia, or quadriplegia?
- Are there NIHSS and GCS scores?
- Was TPA given at the facility or within 24 hours at another facility? Did hemorrhage conversion occur after the TPA was administered?
- Was a thrombectomy performed?