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Aphasia Following a CVA ICD-10-CM

lady in speech therapy trying to match objects to words to improve aphasia
Patient matching objects to words in speech therapy to improve her aphasia following a stroke.

Name That Code

Question: A female patient is seen for a follow-up office visit to evaluate her aphasia that resulted from a previous CVA. The patient has a 20-year history of smoking but quit five years ago.  Assign for ICD-10-CM. 

Answer:

I69.320, Z87.891

The documentation indicates that the aphasia is directly related to a previous CVA. In other words, it is a sequela or late effect of the CVA.

What is a CVA?

CVA stands for cerebrovascular accident. CVA is the medical term for stroke and is also referred to as cerebral infarction or brain attack. A CVA is a sudden loss of neurologic function caused by a loss of blood supply to the brain. 

The National Cancer Institute reports that the risk of stroke is increased by:

  • high blood pressure
  • smoking
  • older age
  • diabetes
  • heart disease
  • atherosclerosis
  • family history of stroke

CVA Can Result in Aphasia

A CVA often leads to cognitive impairment that affects a person’s attention, memory, language, and orientation. Aphasia is a language disorder caused by damage to the part of the brain that controls language expression and comprehension.

According to AHA Journals, approximately one-third of the 25.7 million stroke survivors worldwide experience aphasia, affecting spoken language, auditory and reading comprehension, writing, and everyday communication. 

Note: Aphasia and Aphagia can be confusing. These are two different disorders, and both can occur following a stroke. However, aphagia refers to difficulty in swallowing. Think “s” for speech (aphasia) and “g” for swallowing (aphagia).

ICD-10-CM Coding

Coding for aphasia following a CVA is reported with codes from Chapter 9. Disease of the circulatory system, category I69, Sequelae of cerebrovascular disease. The sequela condition and the causal illness or injury are combined into one code. In this case, the sequela condition is aphasia, and the causal condition is a cerebral infarction. 

Let’s review the pertinent coding guidelines before we look up our codes.

Coding Guidelines – Sequela

According to the ICD-10-CM Official Guidelines for Coding and Reporting, 

“A sequela is the residual effect (condition produced) after the acute phase of an illness or injury has terminated. There is no time limit on when a sequela code can be used. The residual may be apparent early, such as in cerebral infarction, or it may occur months or years later, such as that due to a previous injury. Examples of sequela include: scar formation resulting from a burn, deviated septum due to a nasal fracture, and infertility due to tubal occlusion from old tuberculosis. Coding of sequela generally requires two codes sequenced in the following order: the condition or nature of the sequela is sequenced first. The sequela code is sequenced second.”

“An exception to the above guidelines are those instances where the code for the sequela is followed by a manifestation code identified in the Tabular List and title, or the sequela code has been expanded (at the fourth, fifth or sixth character levels) to include the manifestation(s). The code for the acute phase of an illness or injury that led to the sequela is never used with a code for the late effect.”

Coding Guidelines – Category I69, Sequelae of Cerebrovascular Disease

According to the coding guidelines,

“Category I69 is used to indicate conditions classifiable to categories I60-
I67 as the causes of sequela (neurologic deficits), themselves classified
elsewhere. These “late effects” include neurologic deficits that persist
after initial onset of conditions classifiable to categories I60-I67. The
neurologic deficits caused by cerebrovascular disease may be present
from the onset or may arise at any time after the onset of the condition
classifiable to categories I60-I67.”

“Codes from category I69 may be assigned on a health care record with
codes from I60-I67, if the patient has a current cerebrovascular disease
and deficits from an old cerebrovascular disease.”

Locate and Verify

Aphasia

In the Alphabetic Index, look up Aphasia (amnestic) (global) (nominal) semantic) (syntactic)/following/cerebrovascular disease/cerebral infarction I69.320. 

In the Tabular, we can verify this code as:

I69.320, Aphasia following cerebral infarction

Read the Excludes1, Excludes2, and Use additional notes before making your final code selections. For example, a Use additional note instructs us to code for history of tobacco dependence (Z87.891).

Personal History of Smoking

The documentation for the above coding scenario states that the patient has a history of smoking, and she quit five years ago. So, we would need to add Z87.891 as an additional code.

If we were to look up Z87.891 in the Index, we would go to History/personal (of)/nicotine dependence). It refers us to Z87.891. Verified in the Tabular, the correct code is:

Z87.891, Personal history of nicotine dependence

So, our two codes are I69.320 and Z87.891.

Hopefully, you were able to code this one correctly. If not, you should now better understand CVA and aphasia and how to code for aphasia following a prior CVA. To assign a sequela code, the documentation must indicate that the residual effect (aphasia) was directly related to the underlying illness or injury (CVA). Review all instructional notes and follow the coding guidelines before selecting your final code(s).


4 Comments

  1. I love how you not just give the answer but explain and show how to get the answer. Very helpful, thank you

  2. You have no idea how grateful I am for finally finding somewhere that allows me to practice coding and then after I answer being able to know the very detailed answer to help me understand. I am a freshman in college I am studying medical billing and coding. My goal is to build my career in medical coding. I’m a single mom with two kids and I want to build a brighter future for them and myself. I do have a question for you. So over my studies so far the main thing I am having issues with is knowing exactly what section of the code books to go to when searching for the code with the different classification systems? The other thing I get stumped on is knowing if I have the best and most accurate code for the encounter?

    1. Hi,

      So glad to help. You need to start with the Alphabetic Index and look up the main term. Sometimes, there can be more than one term that will take us to the same code. It’s important to know other terms that mean the same thing. Once you find the correct code or code range, go to the Tabular and read all the notes to see which code best describes what is documented. A code may require 4th, 5th, or 6th characters to fully describe the diagnosis. Read all the coding guidelines and conventions before selecting the most appropriate code. A lot of reading and practice will get you there.

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