Wiki Sequelae Coding Confusion

[staceylh]

Coding guidelines direct us to sequence the manifestation of sequelae first and the actual sequelae code second. However, the tabular under 438.89 instructs to "use additional code" for the manifestation. This is a little confusing; are we ok to use that sequela code as PDx? We've always been told we can't sequence the sequela code first. ??????

 

[Daniel Rowden]

Review the coding guidelines under "Etiology/manifestation convention"

"For such conditions, the ICD-9-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation."

"'Code first' and 'Use additional code' notes are also used as sequencing rules in the classification for certain codes that are not part of an etiology/manifestation combination"

Just like if you were coding gastroparesis due to diabetes ( 250.60 and 536.3) you would code weakness due to CVA as 438.89 and 780.79, the coding conventions direct you to code this way so the PDX would be 250.60 or 438.89 from the above examples. The sequencing guidelines state to do it this way. You never code the manifestation first, you code first the underlying condition unless directed otherwise by the ICD-9-CM coding clinics.

Another example would be Malignant pleural effusion and Malignant lung neoplasm. You would code the PDX as 162.9 malignant lung neoplasm, unspecified and 511.81 malignant pleural effusion when the treatment was directed at the malignant pleural effusion.

Also review the Late effects section in ICD-9-CM:

"Exceptions to the above guidelines are those instances where the late effect
code has been expanded (at the fourth and fifth-digit levels) to include the
manifestation(s) or the classification instructs otherwise. The code for theacute phase of an illness or injury that led to the late effect is never used witha code for the late effect."