How to Improve Late Effects Coding- Published on Mon, Nov 15, 2004
5 strategies keep complications out and reimbursement in
Overlooking late effects ICD-9 codes could mean submitting inaccurate information and possibly compromising physician reimbursement. Fortunately, recognizing late effects can be simple when you use the following five easy strategies.
1. No Time Limits for Late Effects Late effects are the long-term effects of an injury or illness after the acute phase is over. For example, a patient may have a vertebral fracture and continue to have pain years after the fracture heals. Some late effects present early, while others might only become apparent months or years later. "There are no time limits for late effects," says Linda Becker, RN, CMC, physician office manager at Madonna Rehabilitation Hospital in Lincoln, Neb.
The ICD-9 manual provides a separate subsection (905-909) describing "late effects of injuries, poisonings, toxic effects, and other external causes." Late effects that physiatrists commonly see include 905.0-905.9 (Late effect of musculoskeletal and connective tissue injuries), 907.0-907.9 (Late effects of injuries to the nervous system) or 908.6 (Late effect of certain complications of trauma), for example.
Late effects tell the whole story of a patient's condition, and they present a much clearer picture to the carrier of why a physician may choose to treat a patient in a particular way, says Terry Fletcher, BS, CPC, CCS-P, CCS, CMSCS, CMC, a coding and reimbursement specialist in Laguna Niguel, Calif. Specifically, late effects codes link what is going on with the patient now with what happened in the past. "Like E codes for external causes of injury and poisoning, late effects codes provide a more complete picture of the reason for treatment and can become an issue for patients who are injured in an auto accident or in workers' compensation claims," Fletcher says.
As rehabilitation coders, you'll find that you will use late effects codes more than other specialties. "Our outpatient clinic sees patients with residual problems from spinal cord injuries, traumatic brain injuries, orthopedic injuries as well as conditions such as cerebral vascular accident (CVA)," Becker says. "We use a wide range of late effects codes daily."
"We often use codes for late effects of cerebrovascular disease (438.0-438.9)," adds Babette Christofferson, coding and billing specialist at Scottsbluff Physiatry Associates in Scottsbluff, Neb. 2. Use Keywords to Detect Late Effect To determine if a condition is a late effect, you should look for keywords in the physician's documentation. According to Becker, such keywords might include:
due to - such as "pain in right hip due to fracture last year"
following - such as "personality changes following a brain injury in 1996"
as a result of - such as "hemiplegia as a result of CVA"
residual effect - such as "arthritis that is a residual effect of previous hip fracture." Heads-up: Don't confuse late [...]