A stroke – also known as a brain attack – occurs when oxygen supply to the brain is interrupted or when or when a blood vessel in the brain bursts. Stroke is the leading cause of disability and the fifth leading cause of death in the United States. Every year, close to 800,000 people in the U.S. suffer from a stroke. May is observed as Stroke Awareness Month to promote public awareness about this serious medical condition and reduce the incidence of stroke in the country. National Stroke Awareness Month began in May 1989. In 2021, the theme to raise stroke awareness is #RelentlessTogether.
While deaths due to stroke in the U.S. have fallen over the years, the condition is a medical emergency that requires prompt treatment. Effective treatment can prevent long-term disability and save lives. As emergency physicians, cardiologists, and neurologists provide the urgent care stroke patients need, they can rely on outsourced neurology medical billing services to meet their claim submission requirements.
When a stroke occurs, it causes a sudden loss of blood circulation to an area of the brain, which is accompanied by a loss of neurologic function. Stroke awareness means recognizing the symptoms when a person is experiencing a stroke and acting fast.
Stroke Signs and Symptoms
Symptoms occur suddenly and include:
Paralysis, numbness or weakness in the face, arm, or leg, especially on one side of the body
Facial droop, such as side of the mouth drooping to the affected side
Weakness in the arms and difficulty raising both arms
Confusion, trouble speaking clearly or slurred speech and difficulty understanding what others are saying
Vision blurring in one or both eyes
Trouble walking, dizziness, loss of balance, or lack of coordination
Severe headache, often accompanied by vomiting, dizziness or altered consciousness – with no known cause
Signs or symptoms of a stroke may seem to come and go or vanish completely. It is imperative that the person get timely medical attention. There are two reasons why stroke treatment is time sensitive:
Chances of disability or death are higher the longer the person suffers the stroke
Stroke treatment must be provided within a certain window of time after the start of the symptoms
Types of Stroke
Risk factors for stroke include high blood pressure, tobacco use, heart disease, diabetes, being overweight, age, and genetics. There are three types of stroke:
Infarction or Ischaemic Stroke: This is the most common type of stroke caused by a blockage in a blood vessel in the brain.
Haemorrhagic Stroke: This type of stroke occurs when an artery in the brain leaks blood or ruptures and blood seeps into the brain.
Transient Ischaemic Attack (TIA): This is a mini stroke as the blood flow to the brain is blocked for a short time, usually only about 5 minutes. TIA is considered a warning sign and should never be ignored.
The type of symptoms the person has will depend on the size and location of the bleed or blockage and determine the type of treatment required.
If the person is taken to hospital in an ambulance, stroke treatment will begin right away. In the hospital, treatment is administered in the emergency room depending on the type of stroke. Diagnosis will begin with ruling out other conditions with similar symptoms, such as a drug reaction or a brain tumor.
Treatment would begin with taking a detailed medical history and may be followed by various tests and checks such as a neurological examination, blood pressure check, cholesterol and blood tests, ECG (Electrocardiograph), carotid ultrasound, and CT scan/MRI scan. The physician will prescribe medication and recommend follow-up and lifestyle modifications based on the results and patient’s condition.
Documentation and Coding
The ICD-10 codes for stroke are as follows:
160 – Spontaneous subarachnoid hemorrhage I61 – Spontaneous intracerebral hemorrhage I62 – Spontaneous subdural hemorrhage
Acute stroke codes for pre-cerebral arteries
I63.0 – Cerebral infarction due to thrombosis of pre-cerebral arteries 163.1 Cerebral infarction due to embolism of pre-cerebral arteries I63.2 -Cerebral infarction due to unspecified occlusion or stenosis of pre-cerebral arteries
Acute stroke codes for cerebral arteries
I63.3 – Cerebral infarction due to thrombosis of cerebral arteries I63.4 – Cerebral infarction due to embolism of cerebral arteries I63.5 – Cerebral infarction due to unspecified occlusion or stenosis of cerebral arteries I63.6 Cerebral infarction due to cerebral venous thrombosis, non-pyrogenic I63.8 Other cerebral infarction I63.9 Cerebral infarction unspecified G45.9 Transient Ischemic Attack, unspecified
Key Coding Guidelines
Knowing the distinction between cerebral and precerebral arteries is important for coders (hcpro.com). Precerebral arteries are the vertebral, basilar, and carotid arteries and their branches, while cerebral arteries include the anterior, middle, and posterior cerebral arteries and their branches.
Being knowledgeable about terms like stenosis, occlusion, thrombus and embolism is essential to report a code from category I63-I65.
Code category I69 identifies the type of stroke that caused the sequelae as well as the residual condition itself.
A code from category I69 can be reported in conjunction with a condition classifiable to code category I60-I67 if the patient has a current cerebrovascular disease and deficits from an old cerebrovascular disease.
All neurological deficits of a cerebrovascular accident that the patient exhibits during a hospitalization should be reported, even if the deficits resolve before discharge.
Code I61.6 (nontraumatic intracerebral hemorrhage, multiple localized) should be reported if the patient suffered bilateral nontraumatic intracerebral hemorrhages.
If the patient has a history of cerebrovascular disease without any neurologic deficits, code Z86.73 (personal history of transient ischemic attack, and cerebral infarction without residual deficits) should be reported along with a code for the cerebral infarction without residual deficits.
While observing Stroke Awareness Month 2021, the American Stroke Association calls upon physicians to share their stories about stroke, including team work and their amazing patient experiences using the hashtag #RelentlessTogether on their favorite social media channel. The public should educate themselves about the importance recognizing the warning signs of stroke and taking action using the letters in F.A.S.T.
F – Face drooping A – Arm weakness S – Speech slurred T – Time to call 911
The American Stroke Association urges providers to make sure the next year is better for all patients who have suffered a stroke. As they continue their “good fight”, physicians must focus on confirming the accuracy of their diagnoses and ensure that their coding practices comply with all current legal requirements. Partnering with a neurology medical billing and coding specialist can ensure accurate coding and claim submission.