Sequela ICD-10 Guidelines – Comprehending The Difference Between Sequela Vs Subsequent Encounters

The American health association introduces a series of unique codes, edited versions of the previously introduced codes, and rearranged some deleted codes annually to keep updating the list and making it easier for the providers to code and claim. With the introduction of ICD-10 coding guidelines, providers have to bear a new responsibility of meeting each requirement. Not just requirements and guidelines, new concepts are also there to deal with, such as determining the difference between sequela vs subsequent encounters and different diagnosis codes classification.

Coding experts having wide experience are familiar with the initial process of using subsequent and sequelae coding parameters for identifying and recording the reason for patient visits either at a hospital or a clinic. Initial sequelae describe the reason for admitting a patient at a nursing home or a hospital. The physician will be liable to provide the exact symptoms and condition of a patient after their first hospital visit. However, if a provider feels there’s no need of admitting the patient, the first patient visit would be referred to as a consultation. Many times, providers do not identify the codes for consultation, this is where the initial sequelae are used.

On the other hand, when a patient visits a hospital or clinic and gets admitted, the insurance provider adheres to the procedures followed by the hospital or clinic. The services provided at this time will be claimed under the subsequent codes. Once the patient gets discharged after the treatment and after some time again gets admitted for the same reason, the billing process will be made on the initial sequelae encounters which are related to the previously reimbursed bill depicting the repetition of subsequent codes.

ICD-10 coding guidelines

ICD-10 coding guidelines deliver a thorough description for using initial and subsequent coding to determine the range of diseases including injuries, diagnosis, poisoning, etc. Moreover, ICD-10 concepts introduce sequelae encounter codes that are used to show the active phase of treatment and after the subsequent procedure.

According to the ICD-10 coding guidelines, the initial encounter coding concept is to utilize during the treatment. Although, these ongoing treatments are not limited to one physician or one treatment. The initial sequelae include the treatment performed by the doctor, surgical procedures performed by another physician, and the emergency counter.

In accordance with ICD-10 CM codes and guidelines, the initial encounter of a patient is represented by the 7th character of the Letter A. For subsequent encounters, ICD-10 CM says – “once the patient received active treatment for the given condition and has received routine care for the condition throughout the therapeutic or recovery phase.”

An example of this encounter will be a fixation device, medication adjustments, and cast change. For these kinds of subsequent encounters, the letter D is the ICD-10 code.

For sequelae encounters, they have a vast array of diagnoses and diseases that can be counted under them. Some of the uses of these encounters include the complicated diagnosis and treatments that knock just after a concurring health condition. For instance, once a patient starts recovering from a burn injury, the formation of a scar is defined under the ICD-10 guidelines. In such cases when a patient makes the first visit, the initial ICD-10 encounters will be used to show the patient’s first hospital visit.

Continuing the above example, when the buildup of the scar has been seen, the scar would be recorded as a scar using a first encounter code itself in the claim. Besides, the second or the sequelae code will be used for the later diagnosis and treatments planned for later dates to cause the main purpose of the scar – which is burned in this case. The codes will be identified ending with the letter S.

Suppose the burn injury occurs in a real-life so how will ICD-10 coding will be used. A man was injured when the boiling water scald on the left lower left when he was putting it off the stove. He is being treated in a hospital for burn symptoms.

ICD-10 coding guide medical billing

When he first visited the hospital, he was immediately admitted to the hospital and taken to the emergency room. The doctor would suggest using the code T24.032A when he needs to record the initial diagnosis prior to beginning with any procedure. This initial code would describe the injury on the left leg where the degree of a burn and further loss is unspecified. There are other codes that will be used along with T24.032A, which include T31.0 which describes the percentage of burnt body parts which is less than 10%. X12.XXXA is also used to demonstrate the interaction with hot fluids either water or any other.

The use of codes here needs further clarification as the codes would not remain the same when there’s a shift in place of treatment or procedure such as in a clinic, with another physician, or emergency room for instant treatment. If the patient went to another professional as an outpatient for his burn injury treatment continuation, the physician would use the same A letter code to claim for the subsequent injury. The code represents the injury and the associated symptoms of injury, for this reason, the code will remain the same for both treatment places.

However, if the patient visits the same doctor or physician at his private care clinic after having burn treatment in the emergency room of a hospital, the code and encounter use will be entirely different. To bill the situation of hot liquid interaction, the code X12.XXXD will be used. Code T24.032D will be applied for the injuries affecting <10% of the body part. 

It still needs to remain in consideration that the letter A will remain in contact with the subsequent encounters as A symbolizes the treatment of an active injury. Suppose, if the patient needs constant medical interventions if the given medicines are not healing his injury, to bill every encounter, A will be used in the claim for each medical visit and the treatment provided until the patient gets healed, no matter how many visits.

Another situation that changes the encounter is the visitation made after when the burn has healed and the scar buildup has started taking place. The primary care for scar diagnoses will be with the number L90.5. Now the reason for code change will be the subsequent treatment where the main reason for the burn has been healed and the scar treatment will be diagnosed as sequelae. Here T24.0032S will be used as a sequelae encounter code, which denotes the scar treatment not the primary treatment for the actual disease or injury.

Ending note

It might get challenging to comprehend the difference between sequelae vs subsequent at the initial stages of the treatment. However, there are no other codes that describe the scenario this much, you’ll get used to them while using them regularly.

Related Article:

  1. Medical billing and coding study guide – 7 Easy Steps
  2. What Are Specialty Services for Psychiatry Medical Billing?