A common question asked among coders is, “is this a complication or is this a sequela”?  Following specific coding guidelines will ensure that costly errors are avoided for these two very different coding situations.

A sequela (formerly known as “late effects”) is a residual or produced condition that is a result of a past illness or injury. This condition may be apparent in the early stages following an acute phase of an illness or may appear later. However, it is important to note that with a sequela, the acute phase of an illness or injury has resolved or healed, and the sequela is left. Conversely, a complication is a condition that occurs as a result of treatment, or a condition that interrupts the healing process from an acute illness or injury. The acute illness or injury is not healed in a scenario involving a complication.

Two codes are (usually) required for sequela

Most of the time when you’re coding a sequela, you’ll need to use two codes. One of those two codes describe the nature of the sequela (that is, the residual or what you’re seeing right now) and one will describe the now-healed illness or injury that led to the current condition. Coding guidelines stipulate that the residual should be coded first, followed by the healed illness/injury.

For example, if a patient develops a right elbow contracture after a third degree burn in the same area heals, the contracture is the residual and would be coded first with M24.521 (Contracture, right elbow) and immediately followed by T22.321S (Burn of third degree of right elbow, sequela). The seventh character “S” indicates that the burn is no longer an active condition, but rather than it healed and left behind a sequela, according to coding guidelines.

Scenario:   Epilepsy due to Traumatic Brain Injury (TBI)

A 65-year-old woman was a passenger in a car accident five years ago and suffered a TBI. As a result of the TBI, she has recurrent seizures and is admitted to home health for instruction on new medications to help control the seizures.

Primary and Secondary Diagnoses

M1021a:  Epilepsy, unspecified, not intractable without status epilepticus

G40.909

M1023b:  Unspecified intracranial injury without loss of consciousness, sequela

S06.9X0S

M1023c:  Car passenger injured in collision with other type car in traffic accident, sequela

V43.62XS

Rationale:

*Recurrent seizures are sequenced first, as they describe the nature of the sequela.

*A seventh character “S” on the TBI code is used to indicate that the TBI healed but left behind a sequela.

*The appropriate external cause code should be coded using a 7th character of “S” indicating the cause of the accident.

*Even though this accident was 5 years ago, there is no time limit on when sequelae codes can be used.

To read more on Sequelae, you can look for our article in the September edition of Decision Health. To view additional scenarios, see the online version of this story on the Home Health Coding Center at www.HHCodingCenter.com.

About The Contributor

Sheri Ikner, RN, BSN, COS-C, HCS-D

Sheri is a Clinical Manager for OASIS and Coding Services at McBee. She holds the HCS-D and COS-C certifications and has been performing OASIS and coding reviews for 10 years.

Sequelae Frequently Asked Questions

A sequela, formerly known as “late effects,” is a condition that results from a past illness or injury. It can become apparent in the early stages following an acute phase of an illness or may appear later.

A sequela is a residual condition after the acute phase of an illness or injury has resolved or healed. In contrast, a complication is a condition that arises as a result of treatment or interrupts the healing process of an acute illness or injury.

Usually, two codes are required when coding a sequela. One code describes the nature of the sequela (the residual condition), and the other describes the now-healed illness or injury that led to the sequela.

Coding guidelines stipulate that the residual condition should be coded first, followed by the code for the healed illness or injury.

No, there is no time limit on when sequelae codes can be used. They can be applied regardless of how long ago the original illness or injury occurred.

Accurate sequela coding is crucial to avoid costly errors and to correctly represent the patient’s health condition for treatment and billing purposes.

For instance, a patient with a right elbow contracture following a healed third-degree burn would be coded first with M24.521 (Contracture, right elbow) and then T22.321S (Burn of third degree of right elbow, sequela).

Yes, a sequela can become apparent both in the early stages following the acute phase of an illness or injury and also appear later on. The key aspect of a sequela is that it occurs after the acute phase of the illness or injury has resolved or healed.

Examples of sequelae include joint contracture following a tendon injury, hemiplegia after a stroke, or scar formation after a burn. These are conditions that manifest after the acute phase of an injury or illness has passed.

A sequela is used to describe a condition resulting from a previous event. A subsequent encounter, denoted by the seventh character “D” in ICD-10 coding, refers to routine care during the healing or recovery phase of an initial condition.