Basic ICD 10 CMPCS and ICD9 CM Coding
Basic ICD 10 -CM/PCS and ICD-9 -CM Coding, 2015 Edition Chapter 22: Late Effects © 2014
Learning Objectives • Review the chapter’s learning objectives • At the conclusion of this chapter, what must you know about the coding of late effects? 2
Late Effect Definitions in ICD-9 -CM • A late effect is the residual effect, or condition produced and present today, that remains after the acute phase of an illness or injury has terminated 3
Late Effect Definitions in ICD-9 -CM (continued) • This residual effect (also referred to as “the residual”) is the temporary or permanent healthcare problem that follows the acute phase of an illness or injury • The “residual” is the condition or the nature of the late effect that is present today 4
Late Effect Definitions in ICD-9 -CM (continued) • The code for the acute phase of an illness or injury that led to the late effect condition is never used with a code for the late effect • Instead, a code is assigned to identify the original condition that is described as a “late effect” in ICD-9 -CM that is the cause of the residual 5
Late Effect Definitions in ICD-9 -CM (continued) • The coding of late effects generally requires two codes sequenced in order: o (1) Code for the residual • That is, the condition that is present today o (2) Code for the late effect • The code for the late effect describes the original condition, no longer present, that is now producing the residual 6
Main Term for Late Effect Code in ICD -9 -CM • The main term to locate the late effect code in ICD-9 -CM: o Late, effects, (original condition) such as • • • 7 Abscess Burn Crushing injury Fracture Poliomyelitis Tuberculosis
Examples of Late Effects in ICD-9 -CM • Late effects o Hemiplegia following old cerebral thrombosis o Scarring following third-degree burn o Traumatic arthritis following a fracture 8
Examples of Residuals and Causes • Residuals or late effects o Hemiplegia o Scarring o Traumatic arthritis • Causes of the residuals o Cerebral thrombosis o Third-degree burn o Fracture 9
Late Effects of Cerebrovascular Disease in ICD-9 -CM • Coding of late effects of cerebrovascular disease is an example of an exception to the general rule that late effects require two codes • Category 438, Late effects of cerebrovascular disease, provides combination codes that identify both the residual condition and the cause 10
Late Effects of Cerebrovascular Disease in ICD-9 -CM (continued) • The residual condition may be o Cognitive deficits o Aphasia o Hemiplegia • The cause is the cerebrovascular accident • Main term in the Alphabetic Index is o Late, effects, (of) cerebrovascular disease 11
Late Effect Terminology • • • 12 Residuals of Old Sequela of Late Due to or following previous illness or injury
Passage of Time and Residual Effect • No time limit on when a residual can occur • Sufficient time has passed from the occurrence of the acute illness or injury to the development of the residual effect • Some residuals are evident immediately (for example, residuals of CVAs, such as hemiplegia) but other residuals may occur years later 13
Limited Number of Late Effect Codes in ICD-9 -CM • Thirteen category or subcategory codes exist to identify the cause • Late effects of specific diseases are found in ICD-9 -CM chapters related to that disease • Other late effect codes (905– 909) appear in the Injury and Poisoning chapter of ICD-9 -CM 14
Alphabetic Index Entry in ICD-9 -CM • • 15 Code for the cause of the late effect ICD-9 -CM Alphabetic Index to Diseases Main term “Late” Subterm “effect(s) (of)”
Coding Guidelines for Late Effects in ICD-9 -CM • Residual condition or nature of the late effect is sequenced first • Second code is the cause of the late effect • Code for late effect may be followed by a manifestation code identified in the Tabular List 16
ICD-9 -CM Coding Examples • Scar of the right hand secondary to a laceration sustained two years ago o 709. 2, Scar conditions and fibrosis of skin o 906. 1, Late effect of open wound of extremities, without mention of tendon injury 17
ICD-9 -CM Coding Examples (continued) • Dysphasia secondary to old cerebrovascular accident sustained one year ago o 438. 12, Late effect of cerebrovascular disease, speech and language deficits, dysphasia 18
Exceptions to ICD-9 -CM Coding Guideline 1. If the health record does not identify the specific residual effect, code only the late effect code Example: Late effect of polio • 19 138, Late effects of acute poliomyelitis
Exceptions to ICD-9 -CM Coding Guideline (continued) 2. If the Alphabetic Index to Diseases indicates a different sequence, follow the directions of the index Example: Scoliosis due to poliomyelitis in childhood o Index entry: 138 [737. 43] o List code 138 first and code 737. 43 second 20
Exceptions to ICD-9 -CM Coding Guideline (continued) 3. If ICD-9 -CM does not provide a code to describe the cause of the late effect, assign a code for the residual only o Conditions that are stated to be due to previous surgery are not considered late effects o Depending on the circumstances, a history-of code or a surgical complication code may be reported 21
Residual Effect Not Stated in 9 -CM ICD- • If the diagnostic statement does not describe the residual condition o Assign the late effect code only • Example o Diagnosis is “Late effect of rickets” o Code 268. 1, Rickets, late effect, is assigned o Specific effects of rickets are not stated 22
Residual Effect Directed by ICD-9 -CM Alphabetic Index • May find in ICD-9 -CM Alphabetic Index to Diseases under main term for residual o Code for the late effect is listed first o Manifestation code in italics and in slanted brackets follows the code for the late effect • Follow the direction of the ICD-9 -CM Index o Code for the late effect is listed first o Manifestation code is listed second 23
ICD-10 -CM Late Effect or Sequelae Codes • ICD-10 -CM does not contain a single chapter for coding of late effects or sequelae of conditions • These codes are defined into various body system chapters • For example, sequelae of cerebrovascular disease, category I 69, are found in Chapter 9, Disease of the Circulatory System
Coding Guidelines and Instructional Notes for ICD-10 -CM Late Effect or Sequelae Codes • NCHS has published guidelines for late effect or sequelae codes addressing: o Sequela (Late effects) o Sequelae of cerebrovascular disease o Sequelae of pregnancy, childbirth, and the puerperium o Sequelae of injury, poisoning and certain other consequences of external causes
Coding Overview: ICD-10 -CM Late Effect or Sequelae Codes • In the ICD-10 -CM Index to Diseases and Injuries, the main term of “Late, effect(s)” directs the code to another term “Sequelae) • Generally in ICD-10 -CM the terminology of late effects has been replaced by the term sequelae • The Index directs the coder to either a specific sequelae code or to an injury code with the 7 th character of “S”
Coding Overview: ICD-10 -CM Late Effect or Sequelae Codes • Certain codes require a second code for specificity, for example, Alpha Index entry: o Sequelae, disease, cerebrovascular, dysphagia, I 69. 991 • In addition, the coder is directed to use an additional code with I 69. 991 to identify the type of dysphagia (R 13. 1 -) • This code is equivalent to the category 438 codes in ICD -9 -CM that indicates the fact that a past stroke cause the patient’s current problem of dysphagia
Coding Overview: ICD-10 -CM Late Effect or Sequelae Codes • Certain codes require a second code for specificity, for example, Alpha Index entry: o Sequelae, tuberculosis, pulmonary, B 90. 9 • At category B 90, a code first directs the code to code first the condition resulting from the infectious or parasitic condition. • In order words, code first the condition the patient has now as a result of the former or original condition that is coded in addition
Coding Overview: ICD-10 -CM Sequelae of External Cause • Sequela are reported using the external cause code with the 7 th character of S • These codes are used with any report of a sequela resulting from a previous condition • The sequela external cause code is used for subsequent healthcare visits when a late effect of the initial injury is being treated
Coding Overview: ICD-10 -CM Sequelae • Coder should examine the Alphabetic Index entry of “Sequelae” to review all the possible conditions for which late effect or sequelae codes exist
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