Internal Medicine Coding Alert

2 quick tips will keep 'complications' out of your coding

Don't be fooled: For internal medicine practices, diagnosis coding is more complicated than simply remembering to code to the fifth digit. "Late effects" coding is an area of ICD-9 that causes trouble, because many coders are confused about these codes and don't know whether to assign them as primary or secondary codes.

Use these two tips provided by coding experts to ensure you are accurately reporting your internist's       late effect diagnoses.

1. Don't Worry About Time Limits

Late effects are the long-term effects of an injury or illness after the acute phase is over. For example, a trauma patient may continue to have pain and other symptoms years after his various wounds and fractures have healed. Some late effects present early, while others might become apparent months or years later. "There are no time limits for late effects," says Marcella Bucknam, CPC, CCS-P, CPC-H, CCA, HIM program coordinator at Clarkson College in Omaha, Neb.

The ICD-9 manual provides a separate subsection (905-909) describing "Late Effects of Injuries, Poisonings, Toxic Effects, and Other External Causes." For instance, your internist may encounter late effects of injuries to the nervous system (907.x) and late effects of radiation (909.2).

Late effects tell the whole story of a patient's condition, and they present a much clearer picture to the carrier of why a physician may treat a patient in a particular way, says Terry Fletcher, BS, CPC, CCS-P, CCS, CMSCS, CMC, a coding and reimbursement specialist in Laguna Niguel, Calif.

Specifically, late effects codes link what is going on with the patient now with what happened in the past. "Like E codes for external causes of injury and poisoning, late effects codes provide a more complete picture of the reason for treatment and can become an issue for patients who are injured in an auto accident, or in workers' compensation claims," Fletcher says.

To determine whether a condition is a late effect, you should look for key words in the physician's documentation such as "late," "old," "due to," "caused by" and/or "following." "Paralysis due to stroke," for instance, is a clear indication of a late effect of cerebrovascular accident.

Watch out: Late effects and complications are two different things. "A complication describes a problem arising from a condition that still exits. A late effect, on the other hand, is caused by a condition no longer in its acute phase," Bucknam says. Certain conditions such as mal- or non-union of fractures and scarring are inherent late effects, regardless of when they occur.

2. Assign Late Effects as Secondary Diagnoses

When you report late effects of an acute injury, you should code the residual problem/condition as the primary diagnosis and record the appropriate late effects code as a secondary diagnosis, according to ICD-9 guidelines.

How it works: A patient has serious third-degree burns on the left leg (945.45). As the wounds heal, the patient has extensive scarring that requires treatment to relieve pain and restore full range of motion. Report the residual condition first (709.2, Other disorders of skin and subcutaneous tissue; scar conditions and fibrosis of skin), followed by the late effects code (906.8, Late effects of injuries to skin and subcutaneous tissues; late effect of burns of other specified sites), Fletcher says.

In a second example, a trauma patient receives multiple injuries in an auto crash. Several months later, the patient continues to have stomach problems prompted by the crash. In this case, you would report the primary cause for the visit (for instance, nonhealing wound, pain, ulcer, etc.) followed by the late effects code that describes the reason for the injury (908.1, Late effect of internal injury to intra-abdominal organs). To add further specification, you should also report the E code for late effects of motor vehicle accident, E929.0.

Note: Be careful not to confuse the "late effect" E codes with the E codes for current motor vehicle accidents (E810-E819).