Regarded as a serious life-threatening medical condition, stroke occurs when the blood supply to one part of the brain is cut off. According to reports from the American Stroke Association (ASA), stroke is the fifth leading cause of death and disability in the United States. It is estimated that every year, more than 795,000 US people suffer a stroke (2018 statistics). In the United States, about 40 percent of people who die from stroke are males, with 60 percent of deaths occurring in females. Also known as cerebrovascular accident or CVA, the condition occurs when a blood vessel in the brain ruptures and bleeds, or when there’s a blockage in the blood supply to the brain. The rupture or blockage prevents blood and oxygen from reaching the brain’s tissues. CVA is a medical emergency and need to be diagnosed and treated quickly as possible to minimize the chances of brain damage and other related complications. Treatment modality depends on the type and severity of stroke. Maintaining a healthy lifestyle combined with medications can help prevent the condition in an effective manner. Neurologists, neuro-radiologists, neurosurgeons or other specialists who treat different types of stroke need to correctly document the same in the patient’s medical records. Opting for medical billing services from an established medical billing company can help simplify the documentation process.

Here are some frequently asked questions and answers about stroke –

Q: What are the different types of strokes?

A: Stroke comprises three different types –

  • Ischemic stroke – Regarded as the most common type, ischemic stroke is caused by blockages or narrowing of the arteries that provide blood to the brain, resulting in ischemia. Blocked or narrowed blood vessels are caused by fatty deposits that build up in the blood vessels or by blood clots or other debris that travel through your bloodstream and get deposited in the blood vessels in your brain.
  • Hemorrhagic stroke – This occurs when a blood vessel in your brain leaks or ruptures. Leaked blood puts pressure and damages brain cells thereby reducing the blood supply that can reach the brain tissue after the hemorrhage. The ruptures can be caused by conditions like hypertension, trauma, blood-thinning medications, and aneurysms.
  • Transient ischemic attacks (TIAs) – According to the Centers for Disease Control and Prevention (CDC), over a third of people who experience a TIA have a major stroke within a year if they have not received any treatment. Also called mini-stroke, these occur after blood flow fails to reach part of the brain. Normal blood flow resumes after a short amount of time, and symptoms cease.

Q: What causes CVA and what are its potential risk factors?

A: The cause of a stroke depends on the type of stroke. There are two main causes of stroke – a blocked artery (ischemic stroke) or leaking or bursting of a blood vessel (hemorrhagic stroke). Some people may have only a temporary disruption of blood flow to the brain, known as a transient ischemic attack (TIA), that doesn’t cause lasting symptoms. However, the chances of stroke are more likely to affect people if they have the following risk factors like being overweight, having a personal or family history of stroke, have an inactive lifestyle, aged 55 years or older and a tendency to drink heavily, smoke, or use illicit drugs. In addition, medical conditions such as high blood pressure, diabetes, obstructive sleep apnea, cholesterol and cardiovascular disease can also increase the risk of the same.

Q: What are the major signs and symptoms of CVA?

A: Getting familiar with the signs and symptoms of stroke or CVA is the initial step to ensuring that medical help is received immediately. There are different signs and symptoms associated with this condition which include trouble with speaking and understanding, paralysis or numbness of the face, arm or leg (particularly on one side of the body), headache, problem with walking (including dizziness and lack of co-ordination) and vision problems in one or both eyes. In addition to the persistence of the problems listed above, people may also experience some other symptoms like – bladder or bowel control problems, depression, paralysis or weakness on one or both sides of the body, trouble controlling or expressing emotions and pain in the hands and feet (that gets worse with movement and temperature changes).

Q: How to diagnose stroke?

A: Strokes onset rapidly and in most cases occur before an individual can be seen by a physician for a proper diagnosis. For a person experiencing the attacks of stroke, it is important to undergo a proper diagnosis and treatment within the first 3 hours of their symptoms appearing. Diagnosis of CVA will normally begin with a detailed physical examination and analysis of symptoms and review of previous medical history. A neurological exam will also be conducted to see how a potential stroke is affecting the patient’s nervous system.

Physicians will check the blood pressure, listen to the carotid arteries in the neck, and examine the blood vessels at the back of the eyes to check for indications of clotting. They may recommend performing blood tests to find out how quickly the clots occur, the levels of particular substances in the blood, including clotting factors and whether or not an infection is present. Imaging tests like CT scan, MRI scan; Carotid ultrasound (to check the blood flow in the carotid arteries), cerebral angiogram and Echocardiogram will be performed to confirm the type of stroke, its exact causes thereby to prevent unnecessary complications.

Q: What are the treatment options for CVA?

A: Understanding the signs and symptoms of stroke well in advance is the initial step to ensuring that correct treatment is received. It is estimated that for each minute a stroke goes untreated, the blood flow to the brain continues to be blocked and a person loses about 1.9 neurons. This could potentially affect one’s ability to speak, move, memorize and respond to different situations. Therefore, early diagnosis and timely recognition of symptoms can help in better disease management.

Treatment for stroke depends on and varies with the type of stroke a person suffers. Common treatment options include – over-the counter medications (like antiplatelet and anticoagulants, clot-breaking drugs, tissue plasminogen activator (tPA), antiplatelet drugs, anticoagulants, statins and blood pressure drugs) and surgical procedures to remove blood clots. In some cases, surgery may also be required to treat brain swelling and reduce the risk of further bleeding if this was the cause of your stroke. Common surgical procedures include – Carotid endarterectomy, Angioplasty and stents, Coiling (endovascular embolization), surgical clipping and surgical AVM removal. However, if the area of bleeding is large, neurosurgeons may perform surgery to remove the blood and relieve pressure on the brain. Surgery may also be used to repair blood vessel problems associated with hemorrhagic strokes.

Q: What are the ICD-10 codes for diagnosing different types of stroke?

A: Neurologists, Neuro-radiologists, Neurosurgeons or physicians who diagnose, screen and treat CVA must carefully document these tests and procedures using the correct medical codes. Billing and coding services offered by established medical billing and coding companies can help physicians in using the correct codes for their medical billing process.

In ICD-10-CM, code I60 and its complete sub-categories offer more specific representation of the location or source of the hemorrhage –

  • I60 – Nontraumatic subarachnoid hemorrhage
  • I61 – Nontraumatic intracerebral hemorrhage
  • I62 – Other and unspecified nontraumatic intracranial hemorrhage
  • I63 – Cerebral infarction
  • I65 – Occlusion and stenosis of precerebral arteries, not resulting in cerebral infarction
  • I66 – Occlusion and stenosis of cerebral arteries, not resulting in cerebral infarction
  • I67 – Other cerebrovascular diseases
  • I68 – Cerebrovascular disorders in diseases classified elsewhere
  • I69 – Sequelae of cerebrovascular disease

Q: What is involved in stroke recovery and rehabilitation?

A: The impact of your stroke depends on the area of the brain involved and the amount of tissue damaged. After emergency treatment, patients will be closely monitored for at least a day. After-stroke care may help patients recover as much function as possible and return to independent living. If the stroke has affected the right side of the brain, the movement and sensation on the left side of the body may be affected and vice versa. However, brain damage to the left side of the brain may cause serious speech and language problems.

In most cases, stroke survivors may need to attend a rehabilitation program. Physicians will recommend the most rigorous therapy program based on the patient’s age, overall health and degree of disability resulting from stroke.

Q: What steps need to be taken to prevent the occurrence of stroke in the long run?

A: Identifying stroke risk factors, adopting a healthy lifestyle and following physician’s recommendations correctly are the best ways to prevent a stroke. Some of the common prevention strategies include – controlling high blood pressure and diabetes, quitting the usage of tobacco or alcohol, maintaining a healthy body weight, doing regular body exercise, and consuming a diet rich in fruits and vegetables, treating obstructive sleep apnea (OSA), lowering the amount of cholesterol and saturated fat in your diet, and avoiding the use of illegal drugs.