Q: Is there any scenario in which a coder can append a seventh character of “S” (sequela) as the principal diagnosis or first-listed diagnosis?
A:Guidelines written in the chapter-specific section address this question.
In the Chapter 19 guidelines for injuries and poisonings are the following guidelines:
a. Application of 7th characters in Chapter 19, last paragraph
7th character “S,” sequela, is for use for complication or conditions that arise as a direct result of a condition, such as scar formation after a burn. The scars are sequelae of the burn. When using 7th character “S,” it is necessary to use both the injury code that precipitated the sequela and the code for the sequela itself. The “S” is added only to the injury code, the sequela code. The 7th character “S” identifies the injury responsible for the sequela. The specific type of sequela (e.g., scar) is sequenced first, followed by the injury code.
Also, guideline d.7., encounters for treatment of sequela of burns
Encounters for the treatment of the late effects of burns or corrosions (i.e., scars or joint contractures) should be coded with a burn or corrosion code with the 7th character “S” for the sequela.
For example: A patient is seen for revision of scar which is a result of a third-degree burn to the left hand. Documentation states the patient spilled hot water on himself while cooking spaghetti. You would code:
- L90.5, scar conditions and fibrosis of skin
- T23.302S, burn of third degree of left hand, unspecified site, sequela
- X12.xxxS, contact with other hot fluids, sequela
Editor’s note: Jennifer Avery, CCS, CPC-H, CPC, CPC-I, AHIMA Approved ICD-10-CM/PCS Trainer, senior coding instructor at d HCPro, Inc., in Danvers, Mass., answered this question.
This answer was provided based on limited information submitted to JustCoding. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.
Need expert coding advice? Submit your question to Senior Managing Editor Michelle Leppert, CPC, at mleppert@hcpro.com, and we’ll do our best to get an answer for you.