Performance Measurement Network

Question: 433.10 Principal Diagnosis

Patient was admitted through the ED. While in house this patient had multiple diagnoses but none were stroke related. The patient had a neurological consult during admission and the doctor noted "transient episode of loss of consciousness" related to cardiac most likely and that he did not feel there was anything neurological. The CT was normal both times, EEG was normal, and there was no MRI done during the stay. After vascular work up there is documentation that a neurological cause had been completely ruled out as cause of syncope. However the principal diagnosis for this patient was coded to 433.10 Carotid Artery Occlusion/Stenosis without Infarction. This ICD-CM diagnosis code assignment caused this patient to fall into the stroke population.

Should this patient be included in the stroke population? If so, why was this patient given a “stroke diagnosis” when stroke is not mentioned except in the discharge coding process?

Answer:

The "prinicpal diagnosis" is that condition which after study caused the admission. Code 433.10 Occlusion and Stenosis of Cerebral Artery without Infarction is an ischemic stroke code. If the patient was assigned an ICD-9-CM Principal Diagnosis Code of 433.10 at discharge, then the case is in the measure population.

Question Details
Focus area(s): Measure Algorithms – Technical (chart abstracted)
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