A new ICD-9 "V-code" has been approved by the Centers for Medicare and Medicaid Services (CMS) to identify patients who are given tPA (rt-PA) at a differing institution within 24 hours of an admission for ischemic stroke. There is an immediate need to identify the patients who have tPA initiated in one hospital's emergency room and are then transferred for advanced care at a stroke center—a procedure commonly called "drip and ship."
The Academy urges hospital billing staff to begin using this code along with the appropriate primary diagnosis code on October 1, when the new V-code code goes into effect. The use of this code will allow CMS to determine if modifications to existing diagnosis-related groups (DRGs) are needed, or if an entirely new set of DRGs is needed by tracking the number of patients this scenario affects.
V45.88 Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility
Code first condition requiring tPA administration, such as: acute cerebral infarction (433.0-433.9 with fifth-digit 1, 434.0-434.9 with fifth digit 1) acute myocardial infarction (410.00-410.92)
The Academy will begin work immediately with the American Heart Association/American Stroke Association to launch an awareness campaign so that hospital billing staff begin using the code as soon as possible to help CMS in their data collection process.