ICD 10 Coding Alert

Here's the code you should sequence first.

You may know what late effects are in ICD-9, but how do you reflect them in ICD-10-CM? Actually, sequela is the new terminology in ICD-10 and using the sequela extension of "S" replaces the late effects categories (905"909) in ICD-9-CM.

Example: Current late effect code 905.1 (Late effect of fracture of spine and trunk without mention of spinal cord lesion) will become M48.43xS (Fatigue fracture of vertebra, cervicothoracic region, sequela of fracture).

Follow these tips before you report a late effect code, so that your practice is never "late" collecting ethical reimbursement.

Tip 1: Review the Definition

"Sequela" is the new term used for late effects. Remember, a late effect is the residual effect that occurs after the acute phase of an illness or injury has terminated. For instance, you'll report a sequela ICD-10 code for the scar formation after a burn.

Tip 2: Time for Sequela Varies

You won't find any time limit specifying when you can start using a late effect code. Why not? Because late effects vary. The residual effect may be apparent early, such as in the case of a cerebral infarction, or it may occur months or years later, such as an effect due to a previous injury.

Tip 3: Generally, You Need 2 Codes -- In This Order

When you code late effects, you'll generally need two codes. You should sequence the condition or nature of the late effect first. You would code the late effect code second.

For instance, you might report M81.8 (Other osteoporosis without current pathological fracture) followed by E64.8 (Sequelae of other nutritional deficiencies [calcium deficiency]). The condition is osteoporosis, and the late effect is the calcium deficiency.

Exceptions: You may encounter instances when you will report the late effect followed by a manifestation code.

Another situation is when the late effect has been expanded (at the fourth, fifth, or sixth character) to reflect the manifestation. For instance, check out I69.191 (Dysphagia following nontraumatic intracerebral hemorrhage). The "following" means the definition includes the late effect.

You should never report the code for the acute phase of an illness or injury, even if that is what led to the late effect. Also, avoid the activity codes Y93.- or External Cause Status codes Y99.- with sequela(e) codes.

Tip 4: Here's How to Use Extension "S"

If you're looking at injury sequela(e) from ICD-10-CM's Chapter 19, you'll find most codes have a 7th character, which includes the code extension of "S." When using extension "S," you need to use both the injury code that precipitated the sequela and the code for the sequela itself. Bottom line: You'll add the "S" only to the injury code, not the sequela code.

The "S" extension identifies the injury responsible for the sequela. You'll sequence the specific type of sequela (e.g., scar) first, followed by the injury code.

Example: You would report M17.31 (Unilateral post-traumatic osteoarthritis, right knee) followed by S87.01xS (Crushing injury of right knee, sequela).

Tip 5: Examine Pregnancy, Burns, and Coma Scale Scenarios

You have special situations in certain situations.

Burns: You can report both a current burn/corrosion code and a sequela(e) code at the same time. The reason is that burns/corrosions don't heal at the same rate. A patient's healing burn/corrosion may coincide with the sequela(e) of a healed burn or corrosion.

Pregnancy: Code O94 describes the sequela(e) of pregnancy, childbirth, and the puerperium. You'd sequence this second, with the complication first. For instance, you would report O90.81 (Anemia of the puerperium) followed by O94 (Sequela[e] of pregnancy, childbirth, and puerperium).

Coma Scale: If you check out R40.2-, you find codes for the Glascow coma scale (GCS), which do not exist in ICD-9-CM. This is a way for physicians to assess the patient's conscious state, either initially or subsequently. You can use these codes with cerebrovascular disease sequela(e) codes I69.