Medicare Risk Adjustment Coding Focus

Volume 5, Issue 2, February 2018 Last Revised: April 2018

Medicare Risk Adjustment Coding Focus

Sequelae of Stroke: Hemiplegia

code Z86.73 for personal history of Causes cerebral infarction without residual deficits should be utilized. There are multiple causes of hemiplegia, but having a stroke is the most common and can occur at any age. Adults aged 50 years and older are at a higher risk for Hemiplegia and Hemiparesis having a stroke. Additionally, those with Following Cerebral Infarction a secondary condition, such as diabetes (Sequela) and hypertension, or being a smoker, HCC 103 have an increased risk. Most often,

stroke sufferers experience the less I69.351 – affecting right dominant severe form of hemiplegia, called side hemiparesis. However, if over time Overview I69.352 – affecting left dominant side residuals do not diminish, the long term I69.353 – affecting right effect can be hemiplegia. Hemiplegia is defined as paralysis of non‐dominant side partial or total body function on one side I69.354 – affecting left non‐dominant 1 of the body, whereas hemiparesis is Treatment side

characterized by one‐sided weakness but I69.359 – affecting unspecified side without complete paralysis. This Recovery from hemiplegia may be condition affects 8 out of 10 stroke immediate for some, whereas others Z86.73 – Personal history of transient 2 survivors. Hemiplegia occurs when one may take months or even years and ischemic attack (TIA), and cerebral of the corticospinal tracts in the cerebral some may never fully recover. The first infarction without residual deficits (no hemisphere of the brain has been step of treatment is geared toward HCC value) damaged. This neurological condition controlling the underlying cause and

affects everyone differently, with then providing rehabilitation to help variations in the degree of weakness and restore optimal daily living functions. lack of body control on the affected side. Intensive rehabilitative services such as Resources: If the infarction damages the right side physical, speech, and occupational of the brain, the neurological effects therapy, when provided soon after the 1 Hemiplegia. (n.d.) Spinal Cord. would be to the left side of the body and onset of the condition, will help Retrieved January 2, 2018 from vice versa. minimize loss of function. spinalcord.com/hemiplegia 2 Signs and Symptoms Hemiparesis and Hemiplegia. (n.d.) Coding Guidance Stroke‐Rehab. Retrieved January 2, 2018 Signs and symptoms may vary and will from stroke.org 3 depend upon the amount of damage Category I69 of ICD‐10‐CM contains Hemiparesis. (n.d.) We Can Help. that has occurred. As a result, symptoms codes related to the sequelae of Retrieved January 3, 2018 from 4 that may occur due to hemiplegia can cerebrovascular disease. A sequela is a stroke.org 4 range from difficulty with walking, residual effect following an acute phase Schmidt, A., & Patterson, L. (2017). ICD‐ problems with balance, difficulty of an illness or injury which has 10 2018 Professional for Physicians. swallowing, bladder and bowel control terminated. To properly code a sequela, Optuminsight Inc. issues, speech difficulty, muscle documentation must specify the weakness/contractions, and chronic underlying cause, the type of late effect, muscle pain, to name a few.3 These and whether the dominant or non‐ conditions can have a major impact on dominant side is affected, including daily living functions. laterality. If no residuals deficits exist,

Coverage provided by Amerigroup, Inc. Reference the ICD-10-CM codebook, CMS-HCC Risk Adjustment Model V23, and AHA Coding Clinic for complete code sets and official coding guidance. It is not guaranteed that the information supplied is without defect. Any redistribution or other use is strictly forbidden.