Conflicting diagnoses concerning Stroke

Hi all, our hospital is a stroke-certified facility and it has been encouraged that our diagnosed strokes match our stroke registry. We have a current situation where a patient was admitted with stroke-like symptoms and was given tPA with resolution of symptoms. Repeat MRI shows no evidence of ischemia. Neurology states symptoms were due to metabolic state (hyperglycemia) with possible stroke recrudescence-as literature states it would be highly unlikely that MRI shows no ischemia. Hospitalist (attending) on the case continues to call this a "clinical stroke" due to symptomology. He did edit his discharge summary to state aborted stroke (which still codes to the stroke DRG). Coding guidelines state that, in case of disagreement in diagnosis, the attending would be responsible for clarifying the diagnosis. However, with the need for diagnoses to match, would it be appropriate for the "stroke champion" neurologist make an addendum to the discharge summary stating their thoughts. Is it appropriate for coding to code from this addendum instead of the attending's discharge summary?

Thank you in advance!!


  • I would avoid any sort of addendum.

    Sounds like the attending was involved in one or more conversations, and has decided how he feels is most appropriate to describe and diagnose the patient.

    I disagree with "it has been encouraged that our diagnosed strokes match our stroke registry" and "the need for diagnoses to match" -- sounds like there is quite a bit of pressure.

    I am sorry, however I don't see anyway additional avenue to compliantly resolve the apparent disagreement over the most appropriate diagnois.



  • Please see AHA Coding Clinics 1Q 2007 pp 23-24 and the follow-up 3Q 2007 p 12. These may help you.

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