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Acute stroke vs. History of stroke with residual deficits

Would someone clarify for me, and if possible provide supporting documentation, how to code acute strokes with deficits?

I am specifically looking for information on physician coding (not facility) of patients that have been admitted to the hospital. We use a 3M encoder and when a patient comes in with, for example, an acute stroke with facial droop, and left-sided weakness, I’ve been coding I63.9, R29.810, and G81.94. However, an auditor recently told me that I should be coding this as I63.9, I69.354, and I69.992. 3M leads me to the first set of diagnosis codes.

It’s my understanding the I69 codes are for residual deficits of an acute stroke, although these residual deficits can be present at the onset of symptoms. Given that I’m coding for a physician who often times will only see the patient once in consultation, how do we know these deficits are going to be residual? Also, are there some guidelines as to when the acute phase of a stroke is over? Is it at discharge or ??

Thanks in advance!

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