Ask Dr. Z

I code OP accounts for hospital cath labs, and we have a couple of doctors who want to use acute CVA code I63.9 as the only indication for placement an implantable loop recorder, like LINQ 33285. I keep saying that this primary DX is not acceptable because the acute CVA occurred several weeks prior to the OP LINQ placement visit, and in most cases the patient has fully recovered. I find no other DX in the patient record that can be used, such as those suggested in your cardiology desk reference (syncope, arrhythmia, anti-arrhythmic drug monitoring, dizziness). But, when I use Z86.73 history of CVA as a primary diagnosis, I get an error from the encoder saying, "The current primary DX is listed by CMS as and unacceptable primary diagnosis." I believe the doctors want to use the LINQ to look for a latent arrhythmia, but these patients have no documented evidence of any arrhythmia or history of syncope. What can I use as an acceptable primary diagnosis?