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Late Effects (Sequela) in ICD-10-CM

By Bonnie Schreck, CCS, CPC, CPC-H, CCS-P, COBGC
August 10, 2011

A late effect, termed ‘sequela’ in ICD-10-CM, is a chronic or residual condition that is a complication of an acute condition that occurs after the acute phase of a disease, illness or injury. It can also be caused indirectly by the treatment for the disease or condition. There is no time limit on when a late effect can occur; the residual condition may come directly after the disease or condition, or years later.

In the ICD-10-CM code set, instead of using ‘late effects’ (as in ICD-9-CM in code descriptions), the term sequela (singular) or sequelae (plural) is used in describing these diseases or conditions. When looking up ‘Late Effect(s) in the ICD-10-CM Index, it will lead the user to ‘see Sequelae’.

The following examples are the mappings of ICD-10-CM to ICD-9-CM codes:

Example 1

ICD-9-CM Code:

438.9 Late effects of cerebrovascular disease, unspecified

ICD-10-CM Code:

I69.10 Sequelae of nontraumatic intracerebral hemorrhage, unspecified

Example 2

ICD-9-CM Code:

905.1 Late effect of fracture of spine and trunk without mention of spinal cord lesion

ICD-10-CM Code:

M48.43xS Fatigue fracture of vertebra, cervicothoracic region, sequela of fracture

Coding for Sequela(e) (Late Effect)

When coding for sequela(e), there are typically two codes that are required. First listed
is the condition or nature of the sequela(e); and second, the sequela(e) (late effect).

Example:

M81.8 Other osteoporosis without current pathological fracture

E64.8 Sequelae of other nutritional deficiencies (calcium deficiency)

Exceptions to this rule are if the code for the late effect is followed by a manifestation
code, identified in the Tabular List and title or if the late effect code has been included in the fourth, fifth, or sixth character levels to include the manifestation(s).

Example:

I69.191 Dysphagia following nontraumatic intracerebral hemorrhage

Note: Any code that describes the acute phase of an illness or injury should not be used with a code for the sequela(e)(late effect). The exception to this rule is that if both conditions exist, i.e., if the patient has a current cerebrovascular condition as well as deficits from an old cerebrovascular condition.

Injury Sequela(e) Coding

When coding injury sequela(e) out of Chapter 19 in ICD-10-CM, most codes have a 7th character ‘code extension’ of ‘S’. It is used for complications or conditions that arise as a direct result of an injury, such as a fracture or dislocation. The ‘S’ is only added to the injury code, not the sequela(e) of the injury:

M17.31 Unilateral post-traumatic osteoarthritis, right knee

S87.01xS Crushing injury of right knee, sequela

For burns, both a current burn or corrosion code and a sequela(e) code may be reported at the same time. Burns and corrosions do not heal at the same rate so a current healing burn or corrosion may still exist with a sequela(e) of a healed burn or corrosion.

Pregnancy Sequela(e)

ICD-10-CM code O94 describes the sequela(e) of pregnancy, childbirth, and the puerperium. It should be coded as a secondary code, with the complication coded first:

O90.81 Anemia of the puerperium

O94 Sequela(e) of pregnancy, childbirth, and the puerperium

Coma Scale

In ICD-10-CM, there are codes for the coma scale (R40.2-), also known as the Glascow coma scale (GCS), which did not exist in ICD-9-CM. It is an objective way to assess the conscious state of a patient, either initially or subsequently. The coma scale codes can be used in conjunction with cerebrovascular disease sequela(e) codes (I69.-).

Activity and External Cause Status Codes

Activity codes (Y93.-) or External Cause Status codes (Y99.-) should not be reported with any sequela(e) codes.

 

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