Okay, continuing with our Chapter 28 review.
Exercise 28.5 number 4, Cerebral infarction due to thrombosis with a right hemiparesis,
dominant, and aphasia.
This is important to make the distinction between a current hospitalization and any
kind of resulting deficits after the patient leaves the hospital.
This is something that I don't think is explained very well in the code book or in the Coding
Handbook.
So I've built a little table here to show you when you are reporting hemiplegia, if it's
the current hospitalization you're going to code G81.9- even if that hemiplegia or hemiparesis
has resolved by discharge.
It gets the G code.
If you're coding hemiplegia following the cerebrovascular accident or an infarct, that
is now sequela and you're going to use the I69 category.
Here's an example.
Your infarct, cerebral due to thrombosis,
this is your I63 code.
Your hemiplegia, G81.91.
It's this code but you're doing the-- one, two, three- fifth category.
Sorry.
The fifth character 1 because it's the right hand dominant.
And then the aphasia is an R code, R47.01.
So just remember when you're coding, are we coding hemiplegia in the current hospitalization?
If we are, it's a G code.
If you're coding hemiplegia after that hospitalization, the patient has come back in for something
else but with that hemiplegia, now you're talking about an I69 code, a sequela code.
And there is a guideline that directly relates to a sequela.
We'll see in a minute.
Admission for rehab because of monoplegia of the right arm and right leg, each affecting
the dominant side.
The patient suffered a non-traumatic intracranial hemorrhage a month ago.
So because we know this is not the admission, we're talking about a sequela here.
It's going to fall in the I69 codes.
So here's your pathways.
The 6th character 1 for the right dominant is added to both of those codes.
And here is the category that explains why you're using a sequela code.
Exercise 28.6 number 4, acute congestive diastolic heart failure due to hypertension.
I have your pathways here.
Note that there's a "use additional code to identify type of heart failure".
And here it is, diastolic congestive heart failure.
And this instructional note tells us to "code first the heart failure".
So the I11 goes first, then the I50.
And here is the coding guideline that explains how we code
when you have hypertension with heart disease.