Hemorrhagic Conversion
Please, first of all... help us to understand hemorrhagic conversion. We generally see cerebral infarcts without hemorrhage. We recently had a CVA with hemorrhage- would the physician have to document CVA with hemorrhagic conversion in order to code both CVA and hemorrhage?
Any help would be greatly appreciated. Thank you very much!
Comments
Here are two coding clinics that might be helpful to you. Most of our MD's will write hemorrhagic conversion once it happens.
ICD-9-CM Coding Clinic, Third Quarter 2010 Pages: 5-6 Effective with discharges: October 1, 2010
Related Information
Question:
A patient sustained a left frontal cerebral infarction with hemorrhagic conversion. The provider documented that the patient had presented with expressive aphasia due to an acute cerebral infarct and later developed hemorrhagic conversion of the infarct. When queried, the provider stated that the hemorrhagic conversion had occurred spontaneously. What are the correct code assignments for spontaneous hemorrhagic conversion of a cerebral infarction?
Answer:
Assign both code 434.91, Cerebral artery occlusion, unspecified, with cerebral infarction and code 431, Intracerebral hemorrhage. Hemorrhage can spontaneously occur after the original infarct.
ICD-9-CM Coding Clinic, Third Quarter 2010 Page: 5 Effective with discharges: October 1, 2010
Related Information
Question:
A 77-year-old patient was admitted with expressive aphasia secondary to acute cerebral infarction. The patient was given intravenous (IV) tissue plasminogen activator (tPA) within 4.5 hours of the onset of symptoms with significant improvement of aphasia. Brain MRI showed acute left temporoparietal infarct with asymptomatic hemorrhagic conversion. The provider stated that the hemorrhagic conversion was caused by the tPA therapy. What are the code assignments for hemorrhagic conversion of the temporoparietal infarction due to tPA?
Answer:
Assign code 434.91, Cerebral artery occlusion, unspecified, with cerebral infarction, as the principal diagnosis. Assign code 997.02, Iatrogenic cerebrovascular infarction or hemorrhage, and code 431, Intracerebral hemorrhage, for the cerebral hemorrhagic conversion due to the thrombolytic therapy. Assign code 784.3, Aphasia, and code E934.4, Drugs, Medicinal and Biological Substances Causing Adverse Effects in Therapeutic Use, Fibrinolysis-affecting drugs, as additional diagnoses. Code 99.10, Injection or infusion of thrombolytic agent, may be assigned for the infusion of the thrombolytic. Hemorrhage can occur in the space where there is tissue death (infarction) due to the thrombolytic therapy (tPA).
Jeff