Cracking the Code

Coding Sequela Codes

When we look at our FY ICD-10-CM Coding Guidelines, we find detailed information surrounding the coding of a late effect or sequela. As per our ICD-10-CM guidelines, “a sequela 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 sequela code can be used. The residual may be apparent early, such as in cerebral infarction, or it may occur months or years later, such as that due to a previous injury. Examples of sequela can include scar formation resulting from a burn, deviated septum due to a nasal fracture, and infertility due to tubal occlusion from old tuberculosis. Coding of sequela generally requires two codes sequenced in the following order: the condition or nature of the sequela is sequenced first. The sequela code is sequenced second.

An exception to the above guidelines is those instances where the code for the sequela is followed by a manifestation code identified in the Tabular List and title, or the sequela code has been expanded (at the fourth, fifth-, or sixth-character levels) to include the manifestation(s). The code for the acute phase of an illness or injury that led to the sequela is never used with a code for the late effect.

Q: What is the time limit when assigning codes as sequela?
A: There is no time limit on sequelae. Rationale: In our ICD-10-CM Official Guidelines, section I.B.10, states there is no time limit on when sequela codes can be used.
Reference: FY 2023 ICD-10-CM Guidelines
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