Neurology & Pain Management Coding Alert

More detail means claims success If you're overlooking late effects when assigning ICD-9 codes, you're providing incomplete information and possibly compromising both quality of patient care and physician reimbursement. Fortunately, recognizing late effects can be simple when you know what to look for. Late Effects Add Specificity Late effects are the long-term effects of an injury or illness after the acute phase is over. For example, a patient may have a vertebral fracture and continue to have pain years after the fracture heals. Some late effects present early, while others might only 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." Late effects that neurologists commonly see include 905.0-905.5 (Late effect of fracture ...), 907.0-907.9 (Late effects of injuries to the nervous system) or 908.6 (Late effect of certain complications of trauma), for example.
 
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 choose to 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 if a condition is a late effect, you should look for keywords 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 a cerebrovascular accident (CVA).
 
Don't confuse late effects with complications: The two are not the same. "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. Assign Late Effects as Secondary Diagnoses When you report late effects of an acute injury, your primary diagnosis should be the residual problem/
condition. You should list the appropriate late effects code as a secondary diagnosis, according to section 1.7 of the Official ICD-9-CM Guidelines for Coding and Reporting.
 
For example, a patient injures his spinal cord in an auto accident. Some months later, the patient has pain and motor disturbance related to the previous [...]