Sequela ICD 10 Billed as Primary Diagnosis Code

Policy Update #: POLSEQ080124

Effective Date: August 1, 2024

Current State: N/A

Future State: A new edit will be deployed, effective August 1, 2024, to review ICD 10 Sequeladiagnosis codes. A Sequela encounter uses the letter S and indicates a late effect that occurs after the acute phase of the injury or illness has passed. When reporting Sequela(e), you usually will need to report two codes. The first describes the condition or nature of the Sequela(e), and the second describes the sequela(e) or “late effect.” Sequela diagnosis codes reported as the primary diagnosis will be denied.

Applicable Plan(s): Medicaid, Medicare and commercial

Applicable Policy: Policy Number: 3814

Business Owner: Cost of Care

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Sequela ICD Billed as Primary Diagnosis Code