Question: I’m relatively new to coding and my coworker and I are wondering how the definition and usage of sequela in ICD-10-CM differs from an aftereffect? She thinks they are basically the same, but I disagree. Please help us resolve this.
RCI Subscriber
Answer: No, the two terms are not the same, although it’s a widespread misconception that the two are synonymous, and it’s not hard to see why. Let’s first examine the definition of ‘sequela’ as per the ICD-10-CM guideline I.B.10: “A sequela is the residual effect (condition produced) after the acute phase of an illness or injury has terminated. There is no time limit on when a sequela code can be used. The residual may be apparent early, such as in cerebral infarction, or it may occur months or years later, such as that due to a previous injury.” In other words, sequela is a new issue that has developed as a result of a previous issue, such as a scar caused by a previous burn. On the surface, this can appear identical to an aftereffect, but it’s not exactly the same.
While it’s true that most health issues stem from a cause-effect relationship, it’s crucial to understand that causation doesn’t always imply sequela. For instance, complications arising from a medical procedure aren’t considered sequela, nor are symptoms of diseases and conditions triggered by organisms.
Example: Even though you would code a urinary tract infection (UTI) caused by a staph infection with two codes, such as N39.0 (Urinary tract infection, site not specified) and B95.- (Streptococcus, Staphylococcus, and Enterococcus as the cause of diseases classified elsewhere), the UTI in this example is not regarded as a sequela of the infection but a result of it.
Lindsey Bush, BA, MA, CPC, Development Editor, AAPC
