Pat Maccariella‑Hafey
RHIA, CDIP, CCS, CCS‑P, CIRCC
Executive Director Of Education
AHIMA‑Approved ICD‑10‑CM/PCS Trainer and Ambassador
Is your facility reporting the R29.7– ICD-10-CM code for the National Institute of Health Stroke Scale (NIHSS) on patients diagnosed with a stroke? If so, are coders reporting these codes correctly?
What is the Revised Stroke Mortality Measure?
The refined Stroke 30-day mortality measure (MORT-30-STK) is a statistic defined as death occurring within 30 days of a diagnosed stroke. The Centers for Medicare & Medicaid Services (CMS) publicly reports a 30-day hospital-level stroke mortality measure on Hospital Compare as part of the Inpatient Quality Reporting (IQR) program. Measurement of patient mortality allows for a broad view of quality of care that encompasses more than what can be captured by individual process-of-care measures. The goal of outcome measurement is to identify institutions whose performance is better or worse than would be expected based on their patient case mix, by risk adjusting for patients’ conditions at the time of hospital admission. The goal of reporting a stroke outcome measure is to improve patient outcomes by providing patients, physicians, and hospitals with information about hospital-level risk-standardized mortality rates (RSMRs) following hospitalization for acute ischemic stroke.
Hospitals will receive confidential reports for the revised stroke mortality measure in CY 2021 using claims data from October 2017 to June 2020. Results in these reports will not be publicly reported or used for payment determination. CMS will implement the revised stroke mortality measure in the FY 2023 payment determination using claims data from July 2018 to June 2021.
***Hospitals should include the ICD-10-CM code for the NIH Stroke Scale score on submitted claims. The NIH Stroke Scale included in claims should be the first NIH Stroke Scale score documented in the medical record after the patient’s arrival at the hospital. Hospitals should use a POA code of “Yes” to capture the initial NIH Stroke Scale and POA code(s) of “No” to capture the other scores if multiple scores are available.
The NIH Stroke Scale revision only applies to the Stroke MORTALITY measure.
What is the Issue with the NIH Stroke Scale Code?
The problem is that many hospitals have not been reporting the NIH Stroke Scale ICD-10-CM codes as the Official Guidelines for Coding and Reporting have stated reporting of the code is optional. Here is what guideline I. C. 18. i. NIHSS Stroke Scale states:
“The NIH stroke scale (NIHSS) codes (R29.7- -) can be used in conjunction with acute stroke codes
(I63) to identify the patient’s neurological status and the severity of the stroke. The stroke scale codes
should be sequenced after the acute stroke diagnosis code(s).
At a minimum, report the initial score documented. If desired, a facility may choose to capture
multiple stroke scale scores.
See Section I.B.14 for NIHSS stroke scale documentation by clinicians other than patient’s provider”
Since the guideline above states can be used, many coders are not reporting the R29.7- – code.
Coders should be educated on what the NIHSS is and where in the record they can find this information to assign the correct code.
NIH Stroke Scale scores range from 0 to 42, with higher values indicating more severe strokes. The NIHSS is a 15-item neurologic examination stroke scale used to evaluate the effect of acute cerebral infarction/stroke on the levels of consciousness, language, neglect, visual-field loss, extraocular movement, motor strength, ataxia, dysarthria, and sensory loss.
The ICD-10-CM code book index entry is NIHSS (National Institutes of Health Stroke Scale) score R29.7- The NIHSS stroke score can be assigned based on provider or other clinicians’ documentation.
A link is provided below for the criteria used in determining the NIH Stroke Scale score. Coders should not calculate the score as it is to be calculated clinically by the patient’s clinician.
Coding take Away: Always report the NIH Stroke Scale code (R29.7–) on cases with an acute stroke/infarction (I63). Failure to report the code R29.7- – correctly, or at all, will impact the 30-day Stroke Mortality Measure. This data collected from claims since July 2018 will impact reimbursement. It may be a good idea to audit all stroke cases to ensure the correct NIH Stroke Scale code is assigned. Work with the facility’s quality department in determining data reporting periods.
References
Coding Clinic, Fourth Quarter 2016: Page 61
June 27 2018 Hospital Quality Reporting News Blast NIH Stroke Scale
cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/Measure-Methodology.html
qualityreportingcenter.com/wp-content/uploads/2017/08/IQR_FY-2019_Hospital-IQR-Program-Reference-Checklist_Tool_8.21.2017_vFINAL.508.pdf
nihstrokescale.org/
saebo.com/nih-stroke-scale-nihss/
medicare.gov/hospitalcompare/About/Hospital-Info.html
The information contained in this post 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.