RT ICA occlusion stroke converted to hemorrhagic stroke

RochRN@aol.comRochRN@aol.com
in Clinical & Coding

Pt had stroke 3 weeks ago at another hospital. Due to RT ICA occlusion. Home on anticoagulant.  Developed HA and found to have hemorrhagic stroke"likely bled into old stroke region due to anticoagulation" and "hemorrhagic conversion of ischemic stroke due to coagulopathy and supratherapeutic INR"  Coded as I61.1--any way of capturing the previous stroke or conversion?  To me this seems like it should be a late effect or be coded as more than a non traumatic hemorrhage.


Thanks

Comments

  • rwillcuttrwillcutt
    I would code the I61.1 (or a more specific code depending on location), D68.32, Hemorrhagic disorder due to extrinsic circulating anticoagulants, & T45.515A, Adverse effect of anticoagulant, initial encounter.   Depending on the circumstances of the admission, it may be appropriate to sequence either I61.1 or D68.32 as the principal or first listed diagnosis.  You can use a Z code for the RT ICA occlusion.  I wouldn't code it as a late effect as the conversion was due to the anticoagulation, not the stroke. 

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