Cerebrovascular Disease causes, symptoms and risks
“Cerebro” means brain and “vascular” means arteries and veins. Cerebrovascular means blood flow in the brain. A group of conditions that affect the circulation of blood to the brain, causing limited or no blood flow to affected areas of the brain is cerebrovascular disease. High cholesterol levels leads to cholesterol build up in the vessel known as plaque. This condition is called atherosclerosis and is one of the conditions that cause cerebrovascular disease. These conditions limit the flow of blood to the brain leading to complications such as stroke, transient ischemic attacks. Cerebral thrombosis, cerebral embolism, cerebral hemorrhage, aneurysm are the common forms of cerebrovascular disease.
Symptoms of Cerebrovascular disease:
- Hemiplegia
- Hemiparesis
- Location of hemorrhage
- Location of thrombus
- Location of embolus
- Vomitting
- Seizures
- Fever
- Abnormalities in ECG
- Onset of a severe headache
- Onset of hemiplegia
Risk factors:
- Smoking
- High blood pressure
- Carotid or any other artery disease
- History of transient ischemic attacks (TIAs)
- Diabetes
- High blood cholesterol
- Physical inactivity
- Obesity
Uncontrollable risk factors:
- Age
- Gender
- Race
- Heredity
- History of stroke or heart attack
Tests For Cerebrovascular Diseases:
- Cerebral angiography/Vertebral angiogram/Carotid angiogram
- Carotid duplex
- Computed Tomography(CT OR CAT scan)
- Doppler Ultrasound
- Electroencephalogram (EEG)
- Lumbar Puncture (Spinal Tap)
- Magnetic Resonance Imaging (MRI)
- Magnetic Resonance Angiogram (MRA)
- Stroke
Treatment involves:
- Aspirin, Dipyridamole, Ticlopidine, Clopidogrel and Sulfinpyrazone that are blood platelet inhibitors help in reducing the risk of stroke.
- Another way of treatment is Carotid Endarterectomy, an incision made into the carotid artery to remove the plaque.
- Carotid Angioplasty is another way in which a balloon tipped catheter is inserted into the artery and the balloon is inflated to press the plaque and reopen the artery.
Cerebrovascular Disease can be prevented by:
- Quitting smoking
- Regular physical exercise
- Healthy diet
- Maintaining weight
- Controlling blood pressure/Hypertension
- Avoiding stress
- Lowering cholesterol
The ICD-10-CM codes are organized as follows:
-
Non-traumatic intracranial hemorrhage (i.e., spontaneous subarachnoid, intracerebral, or subdural hemorrhages) I60-I62
? These codes specify the location or source of a hemorrhage and laterality.
? Eg : I60.11 ICD-10-CM code denotes nontraumatic subarachnoid hemorrhage from the middle cerebral artery.
? The source of hemorrhage is non-traumatic and the location of middle cerebral artery.
-
Cerebral infarctions (i.e., due to a vessel thrombosis or embolus) I63
? Cause of the ischemic stroke such as thrombosis, embolus.
? Specific location and occlusion in specific artery ( Laterality).
? I63.331 denotes cerebral infarction due to thrombosis of right posterior cerebral artery. Cause is thrombosis and location is cerebral artery in this case.
? A code from category I69 with a condition from code category I60-I67 if the patient has a current cerebrovascular disease and deficits from an old cerebrovascular disease can be reported. Coding guidelines also state that the neurological deficits caused by a stroke may be present from the onset of a stroke or arise at any time after the onset of the stroke.
? Also be aware that codes in category I69 are exempt from POA reporting.
-
Occlusion and stenosis of cerebral or precerebral vessels without infarction I65-I66
? This category codes I65-I66 include bilateral codes. Therefore, if a patient has bilateral stenosis of the vertebral arteries, coders should assign I65.03; not I65.01 and I65.02 to denote the right and left vertebral arteries, respectively.
-
Other cerebrovascular diseases I67-I68
-
Sequelae of cerebrovascular disease (late effect) I69 : “Sequelae” includes conditions specified as such or residuals which may occur at any time after the onset of the causal condition according to the ICD-10-CM Guidelines.
? This code specifies the type of stroke that caused the sequelae and the residual condition.
? ICD-10-CM code I69.01 denotes cognitive deficits after nontraumatic subarachnoid hemorrhage. In this case the residual condition is the cognitive effects and the type of stroke is subarachnoid hemorrhage.
The important key point to remember when reporting codes for cerebrovascular disease in ICD-10-CM. It is critical for coders to understand and differentiate the following terms when reporting a code from category I63-I65:
- Narrowing of artery – Stenosis
- Complete or partial obstruction – Occlusion
- Solid mass of platelets or fibrin that forms and remains in a blood vessel – Thrombus
- Blood clot that travels from the site where it formed to another location in the body – Embolism
- Cerbral arteries include :
- Anterior
- Middle
- Posterior
- Precerebral arteries include :
- Vertebral
- Basilar
- Carotid