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v1.0.0
ICD-10 Guide
ICD-10 CodesG45.1

G45.1

Billable

Carotid artery syndrome (hemispheric)

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 G45.1 is a billable code used to indicate a diagnosis of carotid artery syndrome (hemispheric).

Key Diagnostic Point:

Carotid artery syndrome (hemispheric) refers to a condition characterized by transient ischemic attacks (TIAs) that are caused by insufficient blood flow to the brain due to stenosis or occlusion of the carotid arteries. These episodes are often brief, lasting less than 24 hours, and can manifest as sudden weakness, numbness, or difficulty speaking, typically affecting one side of the body. The underlying pathology often involves atherosclerosis, where plaque builds up in the carotid arteries, leading to reduced cerebral perfusion. This syndrome is a significant risk factor for subsequent cerebrovascular accidents (strokes), making early identification and management crucial for stroke prevention. Patients may present with various neurological deficits that resolve quickly, but the risk of permanent damage increases with recurrent TIAs. Management strategies include lifestyle modifications, antiplatelet therapy, and possibly surgical interventions such as carotid endarterectomy or stenting, depending on the severity of the stenosis and the patient's overall health status.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Differentiating between transient ischemic attacks and other cerebrovascular events.
  • Understanding the nuances of carotid artery disease and its implications.
  • Documenting the duration and nature of symptoms accurately.
  • Identifying risk factors and comorbid conditions that may complicate coding.

Audit Risk Factors

  • Inadequate documentation of symptoms and their duration.
  • Failure to document risk factors such as hypertension or diabetes.
  • Misclassification of TIAs as strokes.
  • Lack of follow-up documentation regarding treatment plans.

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed neurological examination findings, including the nature and duration of symptoms.

Common Clinical Scenarios

Patients presenting with sudden onset of weakness or speech difficulties, followed by resolution of symptoms.

Billing Considerations

Ensure that all TIAs are documented with specific timeframes and risk factors to support the diagnosis.

Cardiology

Documentation Requirements

Assessment of carotid artery disease, including imaging studies and risk factor management.

Common Clinical Scenarios

Patients with a history of cardiovascular disease presenting with TIAs.

Billing Considerations

Documentation should include any interventions performed, such as stenting or endarterectomy.

Coding Guidelines

Inclusion Criteria

Use G45.1 When
  • According to ICD
  • 10 guidelines, G45
  • 1 should be used when the clinical documentation supports a diagnosis of carotid artery syndrome with hemispheric symptoms
  • It is essential to ensure that the symptoms are transient and resolve within 24 hours

Exclusion Criteria

Do NOT use G45.1 When
  • Exclusion criteria include permanent neurological deficits

Related ICD-10 Codes

Related CPT Codes

93880CPT Code

Carotid duplex ultrasound

Clinical Scenario

Used to evaluate carotid artery stenosis in patients with TIAs.

Documentation Requirements

Document the indication for the ultrasound and findings.

Specialty Considerations

Neurologists and cardiologists should ensure that the ultrasound results correlate with clinical findings.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of transient ischemic attacks and related syndromes, improving the accuracy of data collection and reimbursement processes. G45.1 provides a distinct code for carotid artery syndrome, enhancing the ability to track and manage these conditions effectively.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of transient ischemic attacks and related syndromes, improving the accuracy of data collection and reimbursement processes. G45.1 provides a distinct code for carotid artery syndrome, enhancing the ability to track and manage these conditions effectively.

Reimbursement & Billing Impact

reimbursement processes. G45.1 provides a distinct code for carotid artery syndrome, enhancing the ability to track and manage these conditions effectively.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What are the key symptoms of carotid artery syndrome?

Key symptoms include sudden weakness, numbness, difficulty speaking, and visual disturbances, typically affecting one side of the body and resolving within 24 hours.

How is carotid artery syndrome diagnosed?

Diagnosis is based on clinical history, neurological examination, and imaging studies such as carotid ultrasound or CT angiography to assess blood flow and stenosis.