Sequela vs. Late Effects

lisbat

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Good day,

I am working for the State of Oregon DMAP, mapping ICD-10 codes. We are stuck and I am not in agreement with the direction we are taking on sequelas. Firstly, I believe that sequelas can be billed as primary, they disagree. Second, the delineation of what "sequela" is. They are saying that "active treatment" follows the physician, not the condition. I think it is driven by the healing of the condition. Am I right here, or just really confused?

Thanks in advance! :)
 

Monika Liddle

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Sequela

Hi,

Per ICD-10-CM Guidelines Sect I.B.10 -

"A sequel is the residual effect (condition produced) after the acute phase of an illness or injury has terminated. There is no time limit on when a sequela code can be used. The residual may be apparent early, such as in cerebral infarctions, or it may occur months or years later, such that due to a previous injury. Coding of sequela generally requires two codes sequenced in the following order: the condition or nature of the sequel is sequenced first. Then the sequel code is sequenced second.

An exception to the above guidelines are those instances where the code for the sequel is followed by a manifestation code identified in the Tabular List and title, or the sequel code has been expanded (at the 4th, 5th, or 6th character level) to include the manifestation(s). The code for the acute phase of an illness or injury that led to the sequela is never used with a code for the late effects."

From reading the above guidelines, I think there would be certain circumstances where a sequela could be primary. Once the acute phase of the illness of injury has terminated is when you can start coding the sequela.
 

lisbat

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Thank you Monika!

Thanks so much for your response. We are also in disagreement regarding the definition of sequelas. They are saying that a healed state is not considered sequela, and it only relates to further issues with the fracture. So, they want D; subsequent encounters, not S. I look at it like a movie; the sequel, bad or good, came from the first one. Who's right?
 

mitchellde

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Look at the diagnosis from the view of the patient since it is their diagnosis. Second the coding guidelines are specific on which code goes first. Also a late effect is the same as sequela just two different words. To be a sequela there must be some residual condition that is being treated. To just see a patient following an injury to change a dressing or a cast is a subsequent encounter not sequela.
 
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