Coding Tip: New Code for Lacunar Infarction

by | Nov 16, 2018 | Coding Tips, Education, ICD-10, Kim Carrier | 0 comments

Kim Carrier RHIT, CDIP, CCS, CCS-P
Director of Coding Quality Assurance
AHIMA Approved ICD-10-CM/PCS Trainer

For FY 2019, ICD-10-CM has added a new code for reporting of lacunar cerebral infarction. This is good news for coders since we see this specific type of cerebral infarction documented often. The new code that is reported for lacunar infarction is:

  • I63.81—Other cerebral infarction due to occlusion or stenosis of small artery

From ICD-10-CM Alphabetic Index:

Infarction
    Lacunar I63.81

What is a Lacunar Infarction?

Lacunar infarctions result from occlusion in the deep penetrating single small perforating artery in the deep cerebral white matter, basal ganglia, thalamus and brain stem. These small arteries supplies blood to the subcortical areas (deep structures) of the brain. Most of these infarctions are silent. When the blood supply is cut off to these small arteries the brain cells are damaged (killed) due to lack of oxygen. Embolism or thrombus is rarely the cause of this type of infarction as it would be very difficult for an embolus to end up in the small arteries that cause a lacunar infarction/stroke. Lacunar infarctions/strokes account for 20% of all strokes in the U.S. and about 25% of all cerebral infarctions. So, yes, it was time there was a specific code to capture this diagnosis. 25% of patients with this type of cerebral infarction have a second stroke within 5 years (per one study group). A lacunar infarction is diagnosed with the use of CT scan or MRI. Symptoms may occur either fluctuating, sudden or progressively.

Risk Factors for Lacunar Infarction:

  • Hypertension/chronic high blood pressure
  • Heart disease
  • Smoking
  • Diabetes

Symptoms of a Lacunar Infarction:

  • Loss of consciousness
  • Memory problems (recurrent lacunar infarction may cause vascular dementia)
  • Slurring of speech, difficulty speaking or understanding of spoken language
  • Drooping of the face unilaterally
  • Difficulty walking or raising arms
  • Numbness
  • Headache

Treatment of Lacunar Infarction:

  • Intravenous clot-busting drugs (tissue plasminogen activator)
  • Medication delivered directly into the brain
  • High dose aspirin
  • Occupational and physical therapy
  • Heparin has not shown to help patients with lacunar infarction recover as this is used to treat strokes affecting the large arteries of the brain
  • Thrombectomy is not an option as the arteries involved in a lacunar infarction/stroke are too small

Prevention of Lacunar Infarction:

  • Controlling the medical conditions of hypertension and diabetes
  • Taking medications as directed
  • STOP smoking
  • Modify your diet (eat plenty of fruits and vegetables)
  • Exercise regularly

Early treatment of a lacunar stroke may result in full recovery if circulation is restored to the brain quickly.

References
wikipedia.org/wiki/Lacunar_stroke
healthline.com/health/lacunar-stroke-symptoms
drugs.com/health-guide/lacunar-stroke.html
radiopaedia.org/articles/lacunar-infarct
jnnp.bmj.com/content/76/5/617
neuropathology-web.org/chapter2/chapter2bCerebralinfarcts.html
ICD-10-CM Alphabetic Index and Tabular
AHA Coding Clinic for ICD-10-CM and ICD-10-PCS, Fourth Quarter 2018, Page: 16

Happy Coding!

The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.

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