Understanding Stroke and Its Long-Term Impact

Stroke is the third most common cause of disability and the second most common cause of mortality worldwide. The global 30-day fatality rate following an initial ischemic stroke is estimated at 16–23%.

A U.S. study of 220 ischemic stroke survivors revealed a range of neurologic deficits at six months post-stroke, including:

• Hemiparesis (50%)
• Cognitive defects (46%)
• Hemianopia (20%)
• Aphasia (19%)
• Sensory deficits (15%)

Additionally, survivors experienced long-term disabilities such as:

• Depression (35%)
• Inability to walk without assistance (31%)
• Institutionalization (26%)
• Bladder incontinence (22%)

What is a Stroke?

A stroke, also known as a cerebrovascular accident (CVA), occurs when the blood supply to part of the brain is interrupted or reduced, preventing brain tissue from receiving oxygen and nutrients. As a result, brain cells begin to die within minutes.

Types of Strokes

• Ischemic Stroke
  The most common type, accounting for approximately 87% of all strokes. It occurs when a blood clot blocks or narrows an artery leading to the brain.

• Hemorrhagic Stroke
  Occurs when a blood vessel in the brain bursts, leading to bleeding in or around the brain.

Common Late Effects of CVA

• Physical: Hemiplegia, hemiparesis, dysphagia, ataxia
• Cognitive: Memory loss, attention deficits, executive function impairments
• Speech and Language: Aphasia, dysarthria
• Sensory: Visual field loss, neglect (lack of awareness of one side of the body)
• Emotional and Behavioral: Depression, anxiety, personality changes
• Other: Bladder and bowel control issues, fatigue

Recrudescence of Stroke Symptoms

Recrudescence refers to the reappearance of previously resolved neurological deficits from a prior stroke. These symptoms are typically mild, short-lived, and not due to a new stroke.

Key considerations:

• Recrudescence is coded as a “late effect of stroke.”
• Follows the same coding and sequencing guidance as the principal diagnosis (PDX).
• Can be reported alongside a new acute infarction, if applicable.
• Clarity in documentation is essential to accurately capture the etiology of stroke-related symptoms—query the provider if necessary.

Query Example for Clarification

Dear Dr. Carlson,
Patient with PMH of CVA. Per H&P, admitted with “dysphagia.” Other diagnoses include severe malnutrition, with plans for a PEG tube.

Can this patient’s dysphagia be specified as the most likely cause? For example:

• Dysphagia is recrudescence of previous stroke
• Dysphagia related to other (please specify) ___
• Unknown/undetermined

Other clinical indicators/treatment from the patient’s record:

• H&P notes: “dysphagia, severe malnutrition, and failure to thrive. ST/PT/OT to see. Family thinks dysphagia has been going on for a while.”
• Treatment: RD consult, PEG tube placement, PT/OT/ST

Why It Matters:

A favorable query response could shift the DRG from DRG 392 (Esoph, gastro, and misc digestive disorders w/o MCC) with the PDX of dysphagia, to DRG 057 (Degenerative nervous system disorders w/o MCC) with the PDX of weakness/dysarthria as a late effect of CVA.