Question: can we accept a Drs documentation that it is not a hemorragic transformation

even if the nihss is increased by 4 and there is positive imaging.

Answer:

The measure doesn't work that way. A hemorrhagic transformation by definition is: Ischemic stroke patients who develop a symptomatic intracranial hemorrhage (= "Yes" for Positive Brain Image AND greater than or equal to 4 point increase in NIHSS within the first 36 hours after IV/IA t-PA or MER (= Highest NIHSS Score Documented Within 36 Hours Following IV t-PA or IA t-PA or MER minus NIHSS Score Documented Closest to IV t-PA or IA t-PA or MER Initiation). Both conditions must be met to include the case in the numerator. A Positive Brain Bleed alone or a Clinical Deterioration greater than/= to 4 pt NIHSS alone does not put the case in the numerator. Hope this clarifies for you. Thank you for your inquiry.))