2024 The Medical Necessity Series Part III: TIA, Stroke, Encephalopathy (37) – Post Test

1. The educational session noted that there were 3 phases in CT manifestation of stroke. A “subacute” image is indicative of an ischemic event that occurred

2. The National Institutes of Health Stroke Scale (NIHSS) is one tool to use to help determine whether a patient deems to meet medical necessity for inpatient level of care.  Which score below is indicative of such consideration from the 15 elements in the tool? (choose the most correct answer)

3. Documentation to show an inpatient medical necessity for a stroke includes which of the following (choose all that pertain)?

4. A 77-year-old smoker with hypertension presents with BP 165/105 and some slurred speech.  CT and MRI were normal.  BP was treated and the patient was admitted for observation.  On the following morning, vitals are stable and the patient’s speech has returned to normal.  Your neurologic assessment is normal including mentation and gait. The most appropriate diagnosis for this admission is

5. A 67-year-old hypertensive patient notes RUE clumsiness at his evening meal (8pm).  He presents to the ED where a CT is completed showing no acute CVA.  He is placed in-house for OBSERVATION status. The next morning the speech issues have resolved.  The neurological evaluation occurred at 0700 AM, 11 hours after symptom onset.  No thrombolytics were used.  He is discharged but did complete an MRI that was already scheduled before leaving (but after discharge) It shows a small ischemic infarct that appears new in the basis pontis.  The most appropriate diagnosis for this hospital stay is

6. A 67-year-old hypertensive patient notes RUE clumsiness at his evening meal (8pm).  He presents to the ED where a CT is completed showing no acute CVA.  He is placed in-house for OBSERVATION status. The next morning the speech issues have resolved.  The neurological evaluation occurred at 0700 AM, 11 hours after symptom onset.  No thrombolytics were used.  He is discharged but did complete an MRI that was already scheduled before leaving (but after discharge).  It showed a small ischemic infarct that appears new in the basis pontis.  The most appropriate status for this hospital stay is

7. A patient presents with neurologic deficits and a small hemorrhagic acute stroke.  The most appropriate initial admission status is (choose the BEST answer)

8. On the morning of the third hospital day (two midnights after admission), a patient admitted with a “TIA” who had a normal CT is reassessed.  Which of the following would need pristine documentation in the progress note but then clinically merit changing the patient status to inpatient?  (select ALL that would qualify)

9. An insurance company Medical Director is requesting a peer-to-peer discussion about the diagnosis of a patient who presented with a blood pressure of 190/115 and an altered mental state (GCS 11).  The documentation in the chart has both “hypertensive encephalopathy” and “acute confusional state”.  The Medical Director wants to disallow the “encephalopathy” because the record is “lacking supportive information”.  You know that if he is successful, the severity of the DRG will be lowered and less payment (or a denial of payment) will occur.  What information would help you confirm that this patient did have encephalopathy?

10. A left-handed patient is admitted and diagnosed with an acute embolic CVA.  She stayed in-house for 5 days. You are seeing her in follow-up for the Transitional Care Management visit on day 6 after hospital discharge (11 days post-event).  She has functional use of her right hand and arm, better than admission, but not back to 100%.  On the chart, what diagnosis should be placed to capture the condition correctly?