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dalanicks@aol.com

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Hi I have a question, we have a provider that uses X05.72Xs (avulsion of left eye sequel) im getting denials, I know I need a principal diagnosis, but what if I don't have one? any advice would help
thanks
 
What exactly is the provider documenting as the patient's condition that is being evaluated or treated then? Sequela are late effects of an injury or illness, so what is the late effect of this avulsion? Or if these visits are just for continuing treatment and/or monitoring of the original injury, then perhaps the 7th character S is incorrect? Per ICD-10 guidelines: "Coding of sequela generally requires two codes sequenced in the following order: the condition or nature of the sequela is sequenced first. The sequela code is sequenced second."
 
It's hard to recommend codes here without seeing the record. In any case, follow-up visits after treatment for the injury (if that's why the prosthetic eye was placed) would not be sequela, they would be considered subsequent care visits during the healing phase, so would be coded with S05.72XD, not S. However, if the reason for the visit is a complication of the surgery, or a problem due to the device itself, then you'd code from the complication codes instead (e.g. categories T81 or T85). A 'problem seeing' is simply H53.9 unless the record has something more specific.
 
You may also be able to use a Z code. Z44.2 is for fitting/adjustment of eye prosthesis. Without seeing the provider's documentation, it's difficult to provide a definitive diagnosis.
 
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