Traum hemor cereb, w LOC of 30 minutes or less, sequela

This code signifies a long-term effect or complication arising from a traumatic cerebral hemorrhage where the patient experienced a brief loss of consciousness (30 minutes or less) at the time of the initial injury. It indicates that the patient is now presenting for care related to a residual condition directly attributable to that past brain bleed.

Use this code when a patient is being treated for a sequela (e.g., chronic neurological deficits, post-concussive syndrome, cognitive impairment) resulting from a traumatic cerebral hemorrhage that occurred in the past. Documentation must clearly link the current condition to the previous traumatic brain injury and specify the initial loss of consciousness duration as 30 minutes or less.

• Requires a seventh character "S" to indicate sequela, meaning the patient is being treated for the effects of the injury, not the acute injury itself.
• Always sequence the sequela code first, followed by codes for the specific residual conditions being treated (e.g., hemiplegia, aphasia).
• Ensure documentation explicitly states the traumatic nature of the hemorrhage and the duration of loss of consciousness at the time of the original injury.