3 Tips to Determine Proper Sequencing of Late Effects Codes
"A late effect is the residual effect (condition produced) after the acute phase of an illness or injury has terminated. There is no time limit on when a late effect code can be used. The residual may be apparent early, such as in cerebrovascular accident cases, or it may occur months or years later, such as that due to a previous injury. Coding of late effects generally requires two codes sequenced in the following order: The condition or nature of the late effect is sequenced first. The late effect code is sequenced second.
An exception to the above guidelines are those instances where the code for late effect is followed by a manifestation code identified in the Tabular List and title, or the late effect code has been expanded (at the fourth and fifth-digit levels) to include the manifestation(s). The code for the acute phase of an illness or injury that led to the late effect is never used with a code for the late effect."
(ICD-9-CM Official Guidelines for Coding and Reporting Effective October 1, 2009)
To simplify, there are three methods for coding late effects codes.
1) Problem followed by the cause. "The condition or nature of the late effect is sequenced first. The late effect code is sequenced second."
Example: The patient has paraplegia due to a spinal cord injury
1st 344.1 Paraplegia (current problem)
2nd 907.2 Late Effect of Spinal Cord injury (late effect code or cause of the problem)
2) "...the code for late effect is followed by a manifestation code identified in the Tabular List and title."
When the nature of the condition (problem) is a manifestation only code, this code must be preceded by the late effects code since manifestation codes can never be coded first.
Example: The patient has lumbar scoliosis as a result of polio
1st 138 Late Effects of poliomyelitis
2nd 737.43 Scoliosis
In this case, 737.43 Scoliosis is a manifestation only code. Manifestation codes can't be coded first, therefore, in this case, the late effects code must be coded before the problem.
3) Cases where the code includes both the problem and the cause, e.g., some Late Effects of CVA codes. In these instances, "the late effect code has been expanded (at the fourth and fifth-digit levels) to include the manifestation(s)."
Example 1: The patient has hemiplegia of the dominant side as a result of CVA
438.21 Late effect of CVA with hemiplegia dominant side.
This code includes both the nature of the late effect (hemiplegia), and the late effect itself or cause of the problem (CVA).
Some CVA late effects codes require additional codes to further explain the late effect.
Example 2: The patient has dysphagia, pharyngeal phase as a result of a CVA three years ago.
1st 438.82 Dysphagia (late effect of CVA)
2nd 787.23 Dysphagia, pharyngeal phase
Example 3: The patient has generalized muscle weakness as a result of a CVA.
1st 438.89 Other late effects CVA
2nd 728.87 Muscle Weakness (generalized)
(Note: Acute CVAs are never coded in M1020, M1022, or M1024.)
Always consult your ICD-9 coding manual alphabetical index and the tabular list to determine if the proper code(s) have been selected for your patient. Taking steps to properly assign ICD-9 codes is crucial to ensuring that agencies are receiving proper reimbursement and risk adjustment for the patient population they serve, and for maintaining compliance with the ICD-9-CM Official Guidelines for Coding and Reporting.
Kristi R. Wheeler, RN, HCS-D, COS-C is a Clinical Consultant for Kinnser Software, Inc., and the owner of ACCS (Agency Compliance & Consulting Service, LLC.), a company specializing in comprehensive OASIS review and ICD-9 coding. ACCS has a highly trained staff of nurses who have both the HCS-D and COS-C certifications. For more information, contact Kristi at firstname.lastname@example.org or (469)834-3664.