sequela vs initial visit

Hello,

I am probably just wrong, but it is sitting funny with me.

Pt admits for 3rd degree burn ,discharges with wound vac.

Pt comes back to ED for cellulitis, hypotension... Pt has surgical debridement for infected wound.

some people think it is sequela of the original burn, and others think the original burn never healed so it is still initial burn as Pdx.

Input?

thanks!

Comments

  • edited May 2018
    I would place the surgical site infection as the principle diagnosis.  Just like an infected knee prosthesis is not a sequela of a total knee, cellulitis at a burn site would not be one either.

    From the AAPC: 
    What Is Sequela? https://www.aapc.com/blog/27096-initial-subsequent-sequela-encounter/

    ICD-10-CM says the seventh character S is “for use for complications or conditions that arise as a direct result of an injury, such as scar formation after a burn. The scars are sequelae of the burn.” In other words, sequela are the late effects of an injury.

    Perhaps the most common sequela is pain. Many patients receive treatment long after an injury has healed as a result of pain. Some patients might never have been treated for the injury at all. As time passes, the pain becomes intolerable and the patient seeks a pain remedy.

    For example: A patient suffers a low back injury that heals on its own. The patient isn’t seeking intervention for the initial injury, but for the pain that persists long after. The chronic pain is sequela of the injury. Such a visit may be reported as G89.21 Chronic pain due to trauma and S39.002S Unspecified injury of muscle, fascia and tendon of lower back, sequela.

    My litmus test for sequela is whether or not the condition being considered is a "normal" result of the particular injury and cellulitis does not pass the test.

    I deal with a lot of burns here and see MANY subsequent encounters (two-stage grafting process, etc) but not so much sequela, though revision of a painful scar would certainly fit the bill but probably wouldn't be inpatient so likely a moot point.

    Now, as to whether there should be a secondary diagnosis describing the burn that started this whole process, I would think that *if* it is a reportable condition for this encounter, it would be subsequent.

    My $0.02... and maybe only worth $0.01.

    Martin

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