Stroke (also known as cerebrovascular accident or CVA) is the fifth leading cause of death in the United States and a major cause of adult disability. This is a serious, life-threatening medical condition caused when the blood supply to part of the brain is interrupted or severely reduced, depriving brain tissue of oxygen and nutrients. Reports from the Centers for Disease Control and Prevention found that about 8, 00,000 people experience new or recurrent stroke each year.
Several lifestyle factors such as smoking or secondhand exposure to smoke, obesity, physical inactivity, use of illicit drugs (such as cocaine and methamphetamines), and heavy or binge drinking habit can potentially increase the risk of CVA. In addition, medical conditions such as diabetes, hypertension, obstructive sleep apnea, cholesterol and cardiovascular disease can increase the risk of stroke.
A new study found that secondhand smoke (SHS) increases the risk of stroke by about 30 percent for non smokers. The study results published in the American Journal of Preventive Medicine utilized data from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study (a national, population-based, longitudinal review) investigating cardiovascular disease events and mortality endpoints among white and African American adults aged above 45 years.
As part of the current study, researchers analyzed 22,000 participants (38 percent African American, 45 percent male) with about 23 percent reporting SHS exposure in the past year. The key findings include:
- It was found that during the period April 2003 to March 2012 about 428 stroke incidents were reported.
- Researchers found that even after adjusting for other stroke risk factors such as hypertension, diabetes and heart disease, the exposure to secondhand smoke showed 30 percent increase in nonsmokers’ risk of stroke.
- While analyzing the type of stroke, it was found that most strokes were due to blockage of blood flow to the brain (352 ischemic, 50 hemorrhagic, and 26 strokes of unknown subtype).
The study results signify that the possibility of adverse health outcomes such as stroke among non-smokers who are regularly exposed to secondhand smoke is higher. Researchers emphasized the need to investigate the potential role of cardiovascular disease risk factors in the association and explore exposure to additional environmental variables such as ambient air pollutants, in relation to stroke.
Understanding the signs and symptoms of stroke is the primary step to ensuring that medical care is received immediately. There are different signs and symptoms associated with this condition which include paralysis or numbness of the face, headache, problem with walking, difficulty in speaking or understanding things, trouble with seeing in one or both eyes and more. The rate at which these symptoms worsen varies from one person to another.
Physicians play a crucial role in improving a person’s overall health outcome through early and accurate diagnosis and management. If this condition is not treated properly, it can cause temporary or permanent disabilities. As part of an initial diagnosis, physicians may recommend different types of tests such as blood tests, computerized tomography (CT) scan, carotid ultrasound, magnetic resonance imaging (MRI), cerebral angiogram and echo cardiogram to identify the exact causes of this disease.
Neurologists treating stroke patients have to report the correct diagnostic and procedural codes on the medical claims. The following ICD codes are used by physicians and medical coding companies for billing purposes- A study on the difference between ICD-9 and ICD-10 are given below for review.
- 430 Subarachnoid hemorrhage
- 431 Intracerebral hemorrhage
- 432 Other and unspecified intracranial hemorrhage
- 433 Occlusion and stenosis of pre-cerebral arteries
- 434 Occlusion of cerebral arteries
- 435 Transient cerebral ischemia
- 436 Acute, but ill-defined, cerebrovascular disease
- 437 Other and ill-defined cerebrovascular disease
- 438 Late effects of cerebrovascular disease
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
ICD Codes for Secondhand Tobacco Smoke
- E869.4 Second hand tobacco smoke
- Z77.22 Contact with and (suspected) exposure to environmental tobacco smoke (acute) (chronic)
Accurate clinical documentation is crucial for neurologists treating stroke patients. It is important for physicians to ensure that the medical coding and treatment for this condition is checked and audited for accuracy.