Fall back on the guidelines when the going gets tough. As an otolaryngology coder, you will encounter instances in which a prior injury, illness, or disease will exhibit new signs or symptoms after the initial injury or illness has subsided. These manifestations from the previous trauma or illness, also known as sequela effects, can be extremely difficult to grasp from a ICD-10-CM coding perspective. While there are numerous diagnostic considerations to take into account, you've also got to consider the rules ICD-10-CM has implemented in coding for such sequelaeffects. Check out this helpful guide of examples and expert advice to help steer you to success when confronted with any sequela coding scenario. Sequela Defined The ICD-10-CM guidelines define a sequela effect as the following: In respect to the otolaryngology specialty, sequela effects can take on numerous shapes and forms. For example, a patient may experience sequela effects following various surgical procedures of the respiratory system. For example, if a patient suffers from moderate pain in the days following a rhinoplasty, this would simply » be considered a normal symptom from the operation, not a sequela. If, using another example, the patient experiences headaches in the days and weeks while recovering from a facial trauma, you would also not consider these symptoms to be sequela effects. However, if the patient experiences symptoms in the months and years since the patient has fully recovered from the initial traumatic incident or operation, you may consider these symptoms to be sequela effects. With these examples in mind, sequela coding can be understandably difficult do to the subjective nature of the manifestations. Follow the Guidelines on Sequela Coding As you will see in the ICD-10-CM guidelines, the information on sequela coding isn't necessarily localized to one particular section. With this in mind, it's important that coders know how to maneuver through the guidelines to identify all the vital elements within their search criteria. The first point of reference comes with identifying the number and order of codes assigned. ICD-10-CM guidelines state: Example: A patient experiences postnasal drip three months following a nasal fracture. You should code the following diagnoses in the following order: ICD-10-CM uses the example of scar formation following a burn to illustrate the point of using two separate ICD-10-CM codes: However, before you go searching for two separate codes, consider these supplementary guidelines: There's a few points to unpack, here. First, you won't necessarily come across many, if any, examples of a sequela followed by a manifestation code note in the ICD-10-CM tabular. On the other hand, you may come across examples in which a sequela code has been expanded to include manifestations. Consider this non-ENT related example: Example: A patient experiences dysphagia four months following a cerebral infarction. Here, it would be inappropriate to apply two separate codes (dysphagia, cerebral infarction) because one sequela manifestation code already exists. In this example, you would solely apply the following code: Caution: Using the above as an example, there may be instances in which it is difficult to differentiate whether or not the dysphagia is an acute (or chronic) effect versus a sequela effect. "The codes presented in the I69 series are used to report late effects, sequela, of cerebral infarction or hemorrhage and should be used any time after the initial encounter for the stroke," states Sheri Poe Bernard, CPC, of Poe Bernard Consulting in Salt Lake City, Utah. "This essentially means that you use non-I69 codes to describe dysphagia or paralysis that is identified during the hospitalization for stroke. Once the patient is released from the hospital and is being seen for follow-ups, therapies, or other exams, coders should switch to the sequela codes in category I69 to describe the deficit," Bernard explains.