Merit-based Incentive Payment System Value Pathways (MVP) Documentation & Coding Tips:

MVP G0054/Coordinating Stroke Care: Cerebral Infarction Documentation

Lolita M. Jones, MSHS, RHIA, CCS, CRC
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Lolita M. Jones, MSHS, RHIA, CCS, CRC

Merit-based Incentive Payment System (MIPS) Value Pathway G0054 is titled “Coordinating Stroke Care to Promote Prevention and Cultivate Positive Outcomes,” and it focuses on the clinical theme of providing fundamental prevention and treatment of those patients at risk for or that have had a stroke.  One of the Quality Measures (QM) that may be reported for MVP G0054 is QM 187, which is titled “Stroke and Stroke Rehabilitation: Thrombolytic Therapy.”

Measure QM 187 is to be submitted for each episode of acute ischemic stroke for patients (aged 18 years and older) who arrive at the hospital within 3.5 hours of time last known well and for whom intravenous (IV) thrombolytic therapy was initiated within 4.5 hours of time last known well.  It is anticipated that MIPS eligible clinicians providing care for patients with acute ischemic stroke in the hospital setting will submit this measure.

The denominator options included in the QM 187 specification are used to submit the quality actions allowed by the measure, and the eligible denominator criteria include the following stroke ICD-10-CM diagnosis codes:

CodeDescription
I63.00Cerebral infarction due to thrombosis of unspecified precerebral artery
I63.011Cerebral infarction due to thrombosis of right vertebral artery
I63.012Cerebral infarction due to thrombosis of left vertebral artery
I63.013Cerebral infarction due to thrombosis of bilateral vertebral arteries
I63.019Cerebral infarction due to thrombosis of unspecified vertebral artery
I63.02Cerebral infarction due to thrombosis of basilar artery
I63.031Cerebral infarction due to thrombosis of right carotid artery
I63.032Cerebral infarction due to thrombosis of left carotid artery
I63.033Cerebral infarction due to thrombosis of bilateral carotid arteries
I63.039Cerebral infarction due to thrombosis of unspecified carotid artery
I63.09Cerebral infarction due to thrombosis of other precerebral artery
I63.10Cerebral infarction due to embolism of unspecified precerebral artery
I63.111Cerebral infarction due to embolism of right vertebral artery
I63.112Cerebral infarction due to embolism of left vertebral artery
I63.113Cerebral infarction due to embolism of bilateral vertebral arteries
I63.119Cerebral infarction due to embolism of unspecified vertebral artery
I63.12Cerebral infarction due to embolism of basilar artery
I63.131Cerebral infarction due to embolism of right carotid artery
I63.132Cerebral infarction due to embolism of left carotid artery
I63.133Cerebral infarction due to embolism of bilateral carotid arteries
I63.139Cerebral infarction due to embolism of unspecified carotid artery
I63.19Cerebral infarction due to embolism of other precerebral artery
I63.20Cerebral infarction due to unspecified occlusion or stenosis of unspecified precerebral arteries
I63.211Cerebral infarction due to unspecified occlusion or stenosis of right vertebral artery
I63.212Cerebral infarction due to unspecified occlusion or stenosis of left vertebral artery
I63.213Cerebral infarction due to unspecified occlusion or stenosis of bilateral vertebral arteries
I63.219Cerebral infarction due to unspecified occlusion or stenosis of unspecified vertebral artery
I63.22Cerebral infarction due to unspecified occlusion or stenosis of basilar artery
I63.231Cerebral infarction due to unspecified occlusion or stenosis of right carotid arteries
I63.232Cerebral infarction due to unspecified occlusion or stenosis of left carotid arteries
I63.233Cerebral infarction due to unspecified occlusion or stenosis of bilateral carotid arteries
I63.239Cerebral infarction due to unspecified occlusion or stenosis of unspecified carotid artery
I63.29Cerebral infarction due to unspecified occlusion or stenosis of other precerebral arteries
I63.30Cerebral infarction due to thrombosis of unspecified cerebral artery
I63.311Cerebral infarction due to thrombosis of right middle cerebral artery
I63.312Cerebral infarction due to thrombosis of left middle cerebral artery
I63.313Cerebral infarction due to thrombosis of bilateral middle cerebral arteries
I63.319Cerebral infarction due to thrombosis of unspecified middle cerebral artery
I63.321Cerebral infarction due to thrombosis of right anterior cerebral artery
I63.322Cerebral infarction due to thrombosis of left anterior cerebral artery
I63.323Cerebral infarction due to thrombosis of bilateral anterior cerebral arteries
I63.329Cerebral infarction due to thrombosis of unspecified anterior cerebral artery
I63.331Cerebral infarction due to thrombosis of right posterior cerebral artery
I63.332Cerebral infarction due to thrombosis of left posterior cerebral artery
I63.333Cerebral infarction due to thrombosis of bilateral posterior cerebral arteries
I63.339Cerebral infarction due to thrombosis of unspecified posterior cerebral artery
I63.341Cerebral infarction due to thrombosis of right cerebellar artery
I63.342Cerebral infarction due to thrombosis of left cerebellar artery
I63.343Cerebral infarction due to thrombosis of bilateral cerebellar arteries
I63.349Cerebral infarction due to thrombosis of unspecified cerebellar artery
I63.39Cerebral infarction due to thrombosis of other cerebral artery
I63.40Cerebral infarction due to embolism of unspecified cerebral artery
I63.411Cerebral infarction due to embolism of right middle cerebral artery
I63.412Cerebral infarction due to embolism of left middle cerebral artery
I63.413Cerebral infarction due to embolism of bilateral middle cerebral arteries
I63.419Cerebral infarction due to embolism of unspecified middle cerebral artery
I63.421Cerebral infarction due to embolism of right anterior cerebral artery
I63.422Cerebral infarction due to embolism of left anterior cerebral artery
I63.423Cerebral infarction due to embolism of bilateral anterior cerebral arteries
I63.429Cerebral infarction due to embolism of unspecified anterior cerebral artery
I63.431Cerebral infarction due to embolism of right posterior cerebral artery
I63.432Cerebral infarction due to embolism of left posterior cerebral artery
I63.433Cerebral infarction due to embolism of bilateral posterior cerebral arteries
I63.439Cerebral infarction due to embolism of unspecified posterior cerebral artery
I63.441Cerebral infarction due to embolism of right cerebellar artery
I63.442Cerebral infarction due to embolism of left cerebellar artery
I63.443Cerebral infarction due to embolism of bilateral cerebellar arteries
I63.449Cerebral infarction due to embolism of unspecified cerebellar artery
I63.49Cerebral infarction due to embolism of other cerebral artery
I63.50Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebral artery
I63.511Cerebral infarction due to unspecified occlusion or stenosis of right middle cerebral artery
I63.512Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery
I63.513Cerebral infarction due to unspecified occlusion or stenosis of bilateral middle cerebral arteries
I63.519Cerebral infarction due to unspecified occlusion or stenosis of unspecified middle cerebral artery
I63.521Cerebral infarction due to unspecified occlusion or stenosis of right anterior cerebral artery
I63.522Cerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral artery
I63.523Cerebral infarction due to unspecified occlusion or stenosis of bilateral anterior cerebral arteries
I63.529Cerebral infarction due to unspecified occlusion or stenosis of unspecified anterior cerebral artery
I63.531Cerebral infarction due to unspecified occlusion or stenosis of right posterior cerebral artery
I63.532Cerebral infarction due to unspecified occlusion or stenosis of left posterior cerebral artery
I63.533Cerebral infarction due to unspecified occlusion or stenosis of bilateral posterior cerebral arteries
I63.539Cerebral infarction due to unspecified occlusion or stenosis of unspecified posterior cerebral artery
I63.541Cerebral infarction due to unspecified occlusion or stenosis of right cerebellar artery
I63.542Cerebral infarction due to unspecified occlusion or stenosis of left cerebellar artery
I63.543Cerebral infarction due to unspecified occlusion or stenosis of bilateral cerebellar arteries
I63.549Cerebral infarction due to unspecified occlusion or stenosis of unspecified cerebellar artery
I63.59Cerebral infarction due to unspecified occlusion or stenosis of other cerebral artery
I63.6Cerebral infarction due to cerebral venous thrombosis, nonpyogenic
I63.81Other cerebral infarction due to occlusion or stenosis of small artery
I63.89Other cerebral infarction
I63.9Cerebral infarction, unspecified

DOCUMENTATION GUIDELINES:

The clinical documentation for patients diagnosed with a non-traumatic cerebral infarction should include the following:

  • Timeline of the infarction
  • Tissue Plasminogen Activator (tPa) Administration:                                                        
    • Facility where administered (local or referring)
    • Time started
  • Etiology of the infarction:
    • Embolism
    • Occlusion
    • Stenosis
    • Thrombosis – arterial
    • Thrombosis – central venous, nonpyogenic
    • Surgical Intervention
      • Specific name/title of surgical intervention
      • Cause-and-effect relationship between surgery and infarction
      • Intraoperative or Postoperative infarction
  • Site(s) of infarction:
    • Anterior cerebral artery
    • Basilar artery
    • Carotid artery
    • Cerebellar artery
    • Lacunar
    • Middle cerebral artery
    • Posterior cerebral artery
    • Vertebral artery
    • Other artery: specify
  • Laterality of infarction site(s)
    • Left
    • Right
    • Bilateral
  • Hand Preference:
    • Ambidextrous
    • Left-hand dominant
    • Right-hand dominant
  • National Institutes of Health Stroke Scale (NIHSS) Score, which is based on:
    • Level of consciousness
    • Best gaze with horizontal eye movement
    • Extinction/inattention
    • Face symmetry
    • If patient knows the month and own age
    • Language dysarthria
    • Limb ataxia
    • Motor function of each extremity
    • Sensory to skin prick
    • Visual field testing
    • Whether patient can respond to commands to open and close eyes.
  • Manifestations of current infarction:      
    • Alteration in sensation
    • Apraxia
    • Ataxia
    • Cognitive deficits
      • Attention/concentration
      • Cognitive social/emotional
      • Frontal lobe/executive function
      • Memory
      • Psychomotor
      • Visuospatial/spatial neglect
      • Other: specify
    • Disturbance of vision: specify
    • Dysphagia
    • Facial Droop/Weakness
    • Hemiplegia/hemiparesis
      • Laterality
      • Dominant Side
      • Non-Dominant Side
    • Monoplegia/monoparesis
      • Lower limb
      • Upper limb
      • Laterality
      • Dominant Side
      • Non-Dominant Side
    • Other Paralytic Syndrome: specify
      • Laterality
      • Dominant Side
      • Non-Dominant Side
    • Quadriparesis (for patients who have had multiple strokes) 1
    • Speech/language deficits
      • Aphasia
      • Dysarthria
      • Dysphasia
      • Fluency disorder
      • Other: specify
    • Other Deficit(s): specify

CODING GUIDELINES:

  • “Aborted” cerebrovascular infarction is coded as a cerebrovascular infarction in ICD-10-CM.
  • NIHSS scores may be compliantly reported with ICD-10-CM codes (R29.700 – R29.742) based on nonphysician documentation, such as emergency medical technicians (EMTs) or nurses.

For more information download the MVP G0054, the QM187 MIPS CQM Specification, the ICD-10-CM Official Guidelines for Coding and Reporting, and/or contact LolitaMJ@iQueryData.com.

1BERNARD, S. P. (2020). Risk adjustment documentation & coding (2nd ed.). AMER MEDICAL Association.