Difficulty with Cva vs tia
Here is my situation:
Pt (59) teaching started having speech problems. Admitted with aphasia and diagnosis of TIA. They did the regular work up for cva which had not had any positive results (eeg, mri/mra,ct,echo). 3 days later the patient still has the aphasia and some problems with walking per PT consult. I queried for "If there was a probable diagnosis indicating greater acuity as the symptoms have persisted beyond a typical TIA period". I didn't get a response.
I think the neurologist signed off before the query was on chart. I think the primary feels uncomfortable giving a neuro diagnosis that contradicts the neurologists' of TIA, but I think she feels uncomfortable leaving diagnosis of TIA. In her DC summary, she suggests that the patient seek another opinion (the primary was told this was the only Neuro group at out campus, so one wouldn't be available as inpatient).
QUESTION ONE (WHAT DO YOU THINK)
I was thinking of Retro quering the neurologist. I was either going to send a check box form with :
*Tia
*Cva
*Other or
*Unknown
OR (here is where I am wondering what you think)- thinking if he won't commit to cva, the symptom could be coded if he chooses the first choice)
*Aphasia due to tia or cva
*Aphasia due to Cva
*Aphasia due to tia
*Tia
*Cva
*Other or unknown
QUESTION TWO: If he were to select "aphasia due to tia or cva" and the symptom was what was coded... would both tia and cva be coded as secondary dx? and if so would the cva mcc the aphasia? I know it would be better to commit to cva but if he won't cause he doesnt' have positive MRI (or the like) he might check the more arbitrary choice that would take a cc or mcc.
I really appreciate any input you might be able to provide. I have asked my coworkers and the coders.
Pt (59) teaching started having speech problems. Admitted with aphasia and diagnosis of TIA. They did the regular work up for cva which had not had any positive results (eeg, mri/mra,ct,echo). 3 days later the patient still has the aphasia and some problems with walking per PT consult. I queried for "If there was a probable diagnosis indicating greater acuity as the symptoms have persisted beyond a typical TIA period". I didn't get a response.
I think the neurologist signed off before the query was on chart. I think the primary feels uncomfortable giving a neuro diagnosis that contradicts the neurologists' of TIA, but I think she feels uncomfortable leaving diagnosis of TIA. In her DC summary, she suggests that the patient seek another opinion (the primary was told this was the only Neuro group at out campus, so one wouldn't be available as inpatient).
QUESTION ONE (WHAT DO YOU THINK)
I was thinking of Retro quering the neurologist. I was either going to send a check box form with :
*Tia
*Cva
*Other or
*Unknown
OR (here is where I am wondering what you think)- thinking if he won't commit to cva, the symptom could be coded if he chooses the first choice)
*Aphasia due to tia or cva
*Aphasia due to Cva
*Aphasia due to tia
*Tia
*Cva
*Other or unknown
QUESTION TWO: If he were to select "aphasia due to tia or cva" and the symptom was what was coded... would both tia and cva be coded as secondary dx? and if so would the cva mcc the aphasia? I know it would be better to commit to cva but if he won't cause he doesnt' have positive MRI (or the like) he might check the more arbitrary choice that would take a cc or mcc.
I really appreciate any input you might be able to provide. I have asked my coworkers and the coders.