ICD-10: How to Code Sequelae (Home Health Coding Tip by PPS Plus)

Conquer your coding & OASIS challenges with the best home health tips on YouTube: http://ppsplus.com. Master sequelae in ICD-10 by watching this video. PPS Plus’s coding and OASIS review specialist, Rebecca Gruich, will define sequelae, discuss the order of coding, review two exceptions and provide an example using a patient scenario.


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Video Notes:

0:29 Sequelae Defined
0:58 Exception #1
1:14 Example
1:52 Exception #2
2:09 Manifestation Codes
2:29 Final Note

Copy and paste this tip into a Word document for future reference.

The term Sequelae in ICD-10 is replacing what we used to know as “Late Effects” in ICD-9. It is the residual effect that remains after the acute phase of an injury or an illness has resolved. There are no time restrictions on late effects, or sequelae. They may appear early, just after the acute phase of the injury or much later. Just like in ICD-9, you’re going to code what you see first, followed by the sequelae code. The are two exceptions to this rule.

The first is when coding involves a manifestation code, in this instance the etiology/manifestation rule must be followed. And the second is when the chapter specific guidelines direct you otherwise, such in the coding of sequela of nontraumatic CVAs.

For example, a patient had a pelvic fracture years ago and is to receive home health physical therapy for chronic pain which the MD is still relating to the fracture. In this example, the chronic pain is the residual effect of the fracture. You would code the chronic pain first, G89.29, then the sequela code for the pelvic fracture, S32.9XXS. When in the alphabetical index under sequelae, fracture, guidance tells you that sequela of a fracture codes to injury with seventh character S.

Let’s look at one of the exceptions to the above rule. A patient with spondylopathy due to Rickets is to receive home health nursing for pain management. When in the alphabetical index under spondylopathy in diseases classified elsewhere, you will see that this code is a manifestation code. Manifestation codes cannot be used as primary diagnoses and the guidance directs you to code the underlying condition first. In in this case, the sequela of Rickets code (E64.3) would be coded first with the spondylopathy (M49.82) coded directly after.

Just remember it is very important to always read and follow the guidance when coding Late Effects or Sequela.


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