Q&A: Understanding late effects

Q: I am having difficulty understanding “late effects.” The statement of a “condition or nature of the late effect is sequenced first,” but 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, seems contradictory to me. Can you provide some additional context for me?

A: “Late effects” can be a confusing concept, especially for new CDI specialists. Basically, instructions governing this coding direction tells us that the acute phase of a condition must be over before we can assign codes for the late effects caused by that acute condition.

An example sometimes helps us better understand the Official Guidelines for Coding and Reporting for ICD-10-CM.

If a patient presents to the ED suffering from a cerebral vascular accident (CVA) or stoke (this would be considered the acute phase of the condition), coders would choose a code from the circulatory system I63, Cerebral Infarction. With greater specificity, the code could change to reflect details such as the type of stroke and the location. An example would be I63.9, Cerebral Infarction, unspecified. Now, let’s say our patient has hemiplegia related to the CVA and the provider appropriately links the conditions in the chart as related. Then we would also assign a code for the hemiplegia (G81) and, with the appropriate documentation, such as type and dominance, the code could change.

The Official Guidelines for Coding and Reporting tells us that a code for the CVA (acute phase) and the code for late effect of the hemiplegia cannot be coded together on the same encounter. After the “acute phase” of a condition has ended, there are combination codes that represent both the late effect and the condition that caused the late effect, but only after the cessation of the acute phase. The codes under I69, Sequelae of Cerebrovascular disease, would be used and with greater specificity such as type of CVA and type of late effect, coders can assign the appropriate code. An example would be I69.159, Hemiplegia and hemiparesis following non-traumatic intracerebral hemorrhage affecting unspecified side.

These codes highlight the importance of an accurate past medical history. We need to know when a late effect is caused by a current CVA or by a past episode. As a CDI specialist, we need to focus on these details, making sure the coder has the requisite information to accurately code a record.

CDI specialists should also know how conditions are coded and sequenced. In this case, we need two codes. They are sequenced with the condition that caused the late effect first, then a code for the late effect condition. When a CDI specialist knows the rules governing code assignment, they can query effectively to provide the coders with what information they need to accurately code a medical record. 

Editor’s Note: Sharme Brodie RN, CCDS, CDI education specialist and CDI Boot Camp instructor for HCPro in Middleton, Massachusetts, answered this question. For information, contact her at sbrodie@hcpro.com. For information regarding CDI Boot Camps offered by HCPro, visit www.hcprobootcamps.com/courses/10040/overview.