Q&A Late Effect Guidelines

[B.M.W]

Hi, I was going through the guideines and this part is confuses me. Official Guidelines ICD-9 page 19 part #12 "The code for the late acute phase of an illness or injury that led to the late effect is never used with a code for the late effect. What is this mean? Example will be helpful.

Thank you

 

[Ruth Sheets]

The terminology for late effect related codes is not very clear, IMO. (Are they trying to confuse us?) I sort it out like this.

There are 3 codes you have to be aware of when you code for late effect in ICD-9.
A) The code for what is going on now, sometimes called the residual.
B) The code for the original-condition-as-a-late-stage that is now causing the residual condition.
C) The code for the original-condition-as-an-acute-stage (when it first occurred).

You will need to code for A and B. C was coded in the past, but it is important to be aware of the code, just so you DON'T code it now! [Okay there is an exception... but I'll discuss that later.] Sometimes, there is a combination code that encompasses A&B.
Example 1: Pain in the leg resulting from old fracture of the tibia fracture.
When the tibia fracture first occurred (C), it would have been coded 823.80, or some code from 823 - 824 range.
But today, we need to code it's late version (B), so look up Late / effect/ fracture/ extremity/ lower (injury classifiable to 821-827) which points to 905.4. (When we see the"injury classifiable to 821-827" we think "BINGO!" because code C is in this range.) Verify 905.4 in the Tabular.
We need to code the pain in the leg, so look up Pain/ leg which points to 729.5. Verify 729.5 in the Tabular. This is the residual.

Now the Guidelines (I.B.12) says "Coding of late effects general requires two code sequenced in the following order: The condition or nature of the late effect is sequenced first. The late effect code is sequenced second."
Translation into plainer English: "Code the residual first (A), then the condition-as-a-late-stage (B)".

Answer: 729.5, 905.4

Example 2: Facial weakness and vertigo due to CVA 1 month ago.

Facial weakness and vertigo are the "A" type conditions, the residuals, and CVA is the "B" that we need to code for, however...
This is a case where it is helpful to know that Late effects of Cerebrovascular disease have special codes (438.0 through 438.9). Guideline I.C.7.d discusses this and tips us off to look for a combo code to cover the residual effect(s) and the CVA-as-a-late-stage, or an "A&B" code as I call it.

If we look up the acute condition (not that we are going to code it). It would be under Accident/ cerebrovascular 434.91 or in the range of 434.x.

Look up Late/ effect/ cerebrovascular disease (conditions classifiable to 430 -437)/ - say "BINGO" because 434.x is in this range- with facial weakness which points to 438.83.
Next look up Late/effect/ cerebrovascular disease /with vertigo/ which points to 438.85. Verify 438.83 and 438.85 in the Tabular.

So we have two combo codes that are used for the two residuals combined with the Late-stage CVA: 438.83, 438.85.

Now about that exception to "Don't code the acute with the late-stage code"... See Guideline I.C.7.d.2. It says Codes from category 438 may be assigned on a health care record with codes from 430-437, if the patient has a current cerebrovascular accident (CVA) and deficits from an old CVA. So in Example 2, if there was also a current CVA, we would also code 434.91.

There may be other exceptions that I'm not aware of, but in general, the acute condition is not coded with the late-stage version.

Sorry you had to wait so long for an answer to your question. Hope this helps!

 

[B.M.W]

Thank you

 

[Carolyn Heath]

Is the late effects going to change for the ICD-10?

 

[Ruth Sheets]

Interesting question, Carolyn. I'm not an expert in ICD10, but from what I've read, this is how I understand it.

A late effect in ICD-10-CM are called sequela. (The plural is sequelae.) The rules are similar but the codes for acute and sequela are more closely related when you look at them. I think this makes it easier. Also, sometimes in ICD10, the manifestation is indicated by a fourth, fifth or sixth character levels. The code for the acute stage that led to the sequela, is never used with a code for the sequela.



For example, Pain in the leg resulting from old fracture of the tibia fracture.

Some related codes would be:
S82.209A Unspecified fracture of shaft of unspecified tibia, initial encounter for closed fracture This is the acute stage.
S82.209S Unspecified fracture of shaft of unspecified tibia, sequela
M79.606 Pain in leg, unspecified
We still code the residual first, followed by the sequela code: M79.606, S82.209S.

And we don't code the acute stage!

Another example, Facial weakness and vertigo due to CVA 1 month ago.
The acute stage of a CVA would be:
I63.9 Cerebral infarction, unspecified
I69.992 Facial weakness following unspecified cerebrovascular disease
I69.998 Other sequelae following unspecified cerebrovascular disease.
There is a note saying to use additional code to identify the sequelae.
R42 Vertigo
So we would code:
I69.992, I69.998, R42 Again, we don't code the acute stage!


The codes aren't "mapped one-to -one" when going from ICD9 to ICD10, but just follow the Guidelines!
That said, if you see an error in my work, let me know: I'm learning ICD10, too.