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Alternate Level of Care, Neurology


Alternate Level of Care, Neurology HS317b Coding & Classification of Health Data – PowerPoint PPT presentation

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Title: Alternate Level of Care, Neurology

Alternate Level of Care, Neurology
  • HS317b Coding Classification of Health Data

Alternate level of care
  • Mandatory to record ALC via service transfer area
    in DAD in all provinces
  • Designed to separate statistics for true acute
    care patients from those non-acute patients
    occupying acute care beds
  • ALC days removed from DAD before national length
    of stay norms are established.
  • Standardize data collection

  • Has the patient finished the acute care phase of
    his/her treatment but remains in the acute care
  • Awaiting placement (extended care facility,
    hospice, residential care home, community
    services, etc).
  • No respite care available.
  • Diagnosis type W

  • Z50.1 Other physical therapy
  • Z51.5 Palliative care
  • Z54. Convalescence
  • Z59. Problems related to housing and economic
  • Z60.2 Living alone

  • Z74.2 Need for assistance at home and no other
    household member able to render care
  • Z75. Problems related to medical facilities and
    other health care
  • Z76.1 Health supervision and care of foundling
  • Z76.2 Health supervision and care of other
    healthy infant and child

  • WHO defines stroke as rapidly developing
    clinical signs of focal (at times global)
    disturbances of cerebral function, lasting more
    than 24 hours or leading to death with no
    apparent cause other than that of vascular
  • Infarction (ischemic or embolic stroke) or
    hemorrhage (site vascular origin of blood)

Transient Ischemia Attack (TIA)
  • TIA is a focal neurological deficit lasting less
    than 24 hours.
  • Mutually exclusive
  • G45.9 (TIA) cannot be coded in same episode with
    Stroke range I60-I64

Coding Challenge
  • Terminology cerebrovascular accident, CVA,
  • Review Magnetic Resonance Imaging (MRI) or
    Computerized Axial Tomography, (CAT or CT Scan).
    Cerebral angiograms with dye
  • Review Physician documentation for neurologic
    tests to determine functional deficits
  • Apply specificity coding standard

Excludes/Includes I60-I69
  • Includes
  • With mention of HTN in I10 or I15
  • Use additional code to identify presence of HTN
  • Excludes
  • TIA
  • Traumatic intracranial hemorrhage (S06.)
  • Vascular dementia (F01.)

Hypertension typing
  • it is of clinical importance that strokes in
    the presence of hypertension be captured, as HTN
    is implicated in conditions in many body systems
    and is also a stroke risk factor that can be
    medically controlled to a certain extent. The
    hypertension code is captured as diagnosis type 3

Case History HTN Typing
  • (M)I63.4 Cerebral infarction due to embolism of
    cerebral arteries
  • (1) I10.0 Benign Hypertension
  • (3) R47.0 Dysphasia aphasia
  • (3) G51.0 Bells palsy
  • Rationale for HTN as type 1 is that HTN was a
    problem during admission and was stabilized with
    IV Labetalol, therefore it warrants the selection
    of type 1.

Current Stroke vs Old Stroke
  • The stroke is considered to be a current
    condition (I60-I68)
  • during the initial episode of care for the stroke
  • which includes both the acute care
    hospitalization and any subsequent transfer for
    rehabilitation to another facility to continue
    treatment of the associated neurological deficits

Current Stroke vs Old Stroke
  • Stroke is considered to be an old event
  • when there is no longer any neurological deficits
    present (can use Z86.7 Personal history of)
  • There still remains a residual effect from the
    strokewhich has been previously treatedthat
    continues to contribute to another disease
    process or continuing neurological deficit.

Hemorrhage Strokes
  • Subarachnoid hemorrhage (I60)
  • Rupture of cerebral aneurysm or arteriovenous
    malformation within the brain
  • Intracerebral hemorrhage (I61 or I62)
  • Hemorrhage occurs beneath the cerebral cortex
  • This area is responsible for higher brain
    functions, including sensation, voluntary muscle
    movement, thought, reasoning and memory

Cerebral Infarction I63
  • Thrombosis versus Embolism
  • Thrombosis - clot/thrombus forms within the brain
    blocking the flow of blood.
  • Embolism - a clot from elsewhere in the
    circulatory system breaks free and travels
    through the circulatory system, becoming lodged
    in an artery supplying the brain.

Extension of Stroke
  • Extension of a cerebral infarction or stroke must
    be coded as another stroke or cerebral
  • If it occurred during same episode of care apply
    diagnosis type 2

Sequelae Postop Strokes
  • Sequelae (I69) (late effect) indicate conditions
    in I60-I67 as the cause of a sequelae, themselves
    classified elsewhere (Sequelae Dx cannot be M)
  • Postop-stroke code from I60-I67 is coded with
    external cause based on time of occurrence.

Neurological Deficits
  • Neurological deficits
  • Paralysis, dysphagia, aphasia, urinary
    incontinence and fecal incontinence
  • All neurological deficits affecting the
    management and treatment of the patient during
    the acute phase of the condition may be coded as
    a comorbid condition

Criteria for R13, R15 or R32
  • R13 Dysphagia Dx type 1
  • if requiring nasogastric tube/enteral feeding
  • If still requiring treatment more than 7 days
    after the stroke occurred

Criteria for R13, R15 or R32
  • R15 Faecal incontinence-Dx type 1
  • If still present at discharge or persists for at
    least 7 days
  • R32 Unspecified urinary incontinence Dx type 1
  • If still present at discharge or persists for at
    least 7 days

G46. Vascular Syndromes Following Stroke
  • G46. used when certain constellations of signs
    and symptoms are documented in the chart as due
    to a hemorrhage or infarct affecting particular
    areas of the brain.
  • When it is the result of a stroke, codes in the
    range I60-I67 become dagger codes and G46.

  • Patient admitted with a constellation of
    neurological deficits in a documented brain stem
    thrombosis and infarction, leading to a diagnosis
    of Webers syndrome
  • (M) 163.3 Cerebral Infarction due to thrombosis
    of cerebral arteries
  • (3) G46.3 Brain stem stroke syndrome (includes
    Webers Syndrome)

Classification based on MRDx
  • MCC 1 Diseases and Disorders of the Nervous
  • CMG 13 Specific cerebrovascular disorders
  • Medical includes SAH, ICH, SDH, stroke NOS
  • With surgery, i.e. Drainage of SDH CMG 1
    Craniotomy procedures