I code the first documented NIH score in case the patient has
an established diagnosis of stroke. The scores can vary depending on interval
changes in level of consciousness or neurological deficits resolving as a
result of intervention from the clinical staff. Also note if CVA was
subsequently ruled out, I would not code the NIH score since it’s a tool used for objectively quantifying the impairment
caused by a stroke. When in doubt query the provider if there is conflicting
documentation. Great question!