Health Information Management

Tip: Note disconnect between late effect terminologies in guidelines vs. indices

CDI Strategies, December 8, 2011

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By Jennifer Avery, CCS, CPC, CPC-H, CPC-I

Late effects are considered to be the residual effects after the acute phase of an illness, disease, or injury. There is no time limit as to when a late effect can manifest itself. It can occur directly after the disease or even years after the illness or injury has passed.
ICD-9-CM coding for late effects varies depending on whether combination codes exist, such as with cerebrovascular accidents (CVA), for which a combination code identifies the residual condition and that it is a late effect of a CVA. Late effects can require coders to report multiple codes to identify the condition, such as with accidents or injuries for which you need separate codes to identify the:
  • Current (residual) problem
  • Condition as a late effect of an injury
  • External cause (E code) to identify the cause of the injury that resulted in the late effect
When we move to ICD-10-CM, late effects are termed sequela (singular) or sequelae (plural). If you look up the term “late effect” in the alphabetic index of the draft ICD-10-CM Manual, an instructional note states “see Sequelae.” This includes looking up the additional external cause status codes. The alphabetic index references you to “see Sequelae.” So we are going to have to get used to the change in terminology. As a coding instructor, I already identify this change in terminology with my students so that they can get used to the verbiage.
It gets confusing, however, when you look at the ICD-10-CM Official Coding Guidelines for Coding and Reporting. For example, if you look at the chapter-specific guidelines for “Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes,” the guidelines make several references to coding for “late effects.” In “Chapter 20: External Causes of Morbidity,” the guidelines also reference coding for late effects.
Editor’s Note: This article was originally published on the ICD-10 Trainer Blog.

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