ICD-10 Coding for Personal History of Cerebrovascular Accident(Z86.73)
Complete ICD-10-CM coding and documentation guide for Personal History of Cerebrovascular Accident. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Personal History of Cerebrovascular Accident
Z86.73Primary Range
Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits
This code is used to document a patient's history of cerebrovascular accident (CVA) without any residual neurological deficits.
Sequelae of cerebrovascular disease
Used when there are residual effects from a previous cerebrovascular accident.
Key Information: ICD-10 code for personal history of CVA
Essential facts and insights about Personal History of Cerebrovascular Accident
Primary ICD-10-CM Code for personal history of costovertebral angle
Decision Criteria
clinical Criteria
- Patient has a history of stroke with no current neurological deficits.
documentation Criteria
- Documented normal neurological exam and patient history indicating no residuals.
Applicable To
- History of stroke without residuals
Excludes
- Sequelae of cerebrovascular disease (I69.-)
Clinical Validation Requirements
- Normal neurological exam
- No residual deficits noted in patient history
Code-Specific Risks
- Incorrectly coding when residuals are present
Coding Notes
- Ensure thorough documentation of the absence of residuals to justify the use of Z86.73.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Hemiplegia and hemiparesis following cerebral infarction affecting right dominant side
I69.351Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Personal History of Cerebrovascular Accident to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Z86.73.
Impact
Clinical: Misrepresentation of patient's current health status., Regulatory: Potential audit issues due to incorrect coding., Financial: Incorrect billing and reimbursement.
Mitigation Strategy
Verify absence of residuals before coding, Consult with neurology if uncertain
Impact
Reimbursement: Incorrect reimbursement due to improper code usage., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate patient records affecting data quality.
Mitigation Strategy
Use I69.- codes for any residual effects from a stroke.
Impact
Using Z86.73 when residuals are present can lead to audit issues.
Mitigation Strategy
Ensure thorough documentation and verification of no residuals.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Personal History of Cerebrovascular Accident, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Personal History of Cerebrovascular Accident
Use these documentation templates to ensure complete and accurate documentation for Personal History of Cerebrovascular Accident. These templates include all required elements for proper coding and billing.
Neurology Follow-Up for Stroke History
Specialty: NeurologyRequired Elements
- Patient history
- Neurological exam
- Imaging results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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