Performance Measurement Network

Question: ICD-9-CM Code 433.10

This question has follow-up question(s): Admitted for elective carotid intervention, Code 433.10 and Transient Ischemic Attack

Why is 433.10 not considered an exclusion to the stroke population?


An ICD-9-CM Principal Diagnosis Code of 433.10 "Occulsion and Stenosis of the Carotid Artery without Cerebral Infarction" is not an exclusion. It is listed in the ICD-9-CM Code Appendix as an ischemic stroke code and should be included in the measure population with the other ischemic stroke codes specified.

Please refer to the stroke initial patient population algorithm. The decisions following "Principal Diagnosis" are patient age "18 years or Older" and "Admitted for Elective Carotid Intervention". The exclusion of code 433.10 will be made at the decision point for "Admitted for Elective Carotid Intervention". To answer "Yes" for this decision point, there must be documentation present in the medical record that the patient was admitted solely for the purposes of elective carotid intervention.

Although code 433.10 is commonly used for patients admitted for elective carotid intervention, every patient assigned 433.10 as a principal diagnosis code at discharge was not admitted for an elective procedure. The code is used for other stroke conditions, e.g. lacunar stroke syndrome without evidence of infarction on CT. Therefore, a case cannot be excluded on the basis of code 433.10 alone.

Question Details
Focus area(s): Chart Abstracted Measure Specifications – Clinical, Related Manual - Data Quality Manual
Related documents: STK, ICD-9-CM Principal Diagnosis Code, Appendix: Code tables

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