The Importance of the 7th Character in ICD-10-CM

July 27th, 2017 - Chris Woolstenhulme, CPC, CMRS
Categories:   Coding  

There is still confusion on the use of the seventh character. Let's clarify a few common areas.

  • The 7th character represents the physicians encounter, but not the number of visits.
  • Reporting the phase of treatment the patient is seeing the provider for, but not the number of injuries or number of visits.

The most common seventh character extension is used to capture information about the phase of treatment.

A- Initial Encounter: Active treatment or initial encounter for an injury, poisoning, or other consequences of and external cause.  The initial encounter can occur more than once and can be used any time during active treatment of the same encounter.  For example; if the practitioner sends the patient to the Emergency room, then is seen by a radiologist, all three treating providers would code the injury with "A" Initial Encounter.  

DSubsequent Encounter: Used during the healing phase after the active phase; this may be seen to ensure the patient is healing correctly. 

S- Sequela: Complications or conditions as a direct result of a previous injury; for exapmle, a scar from a burn. 

Category S42 requires more specifics on the state of the fracture (Fracture of shoulder and upper arm):

A - Initial encounter for closed fracture
B - Initial encounter for open fracture
D - Subsequent encounter for fracture with routine healing
G - Subsequent encounter for fracture with delayed healing
K - Subsequent encounter for fracture with nonunion
P - Subsequent encounter for fracture with malunion
S - Sequela

When coding extremities, fractures are based on Gustilo open fracture classifications. For example, this would apply when reporting codes for fractures in Category S52 (Fracture of the forearm), S72 (Fracture of Femur) and S82 (Fracture of Lower Leg). 

The following extensions are to be used to ensure a complete code:

B - Initial encounter for open fracture type I or II
C - Initial encounter for open fracture type IIIA, IIIB, or IIIC
E - Subsequent encounter for open fracture type I or II with routine healing
F - Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing
H - Subsequent encounter for open fracture type I or II with delayed healing
J - Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing
M - Subsequent encounter for open fracture type I or II with nonunion
N - Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion
Q - Subsequent encounter for open fracture type I or II with malunion
R - Subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion

To provide additional specificity, the fracture extensions require the following seventh character. Coding the encounter and the phase of treatment are combined in this group of characters used for fractures: 

A - Initial encounter for closed fracture
B - Initial encounter for open fracture
D - Subsequent encounter for fracture with routine healing
G - Subsequent encounter for fracture with delayed healing
K - Subsequent encounter for fracture with nonunion
P - Subsequent encounter for fracture with malunion
S - Sequela

Using the "X" place holder

Each chapter may have different requirements or may not have a seventh character at all, however; if there is a seventh character required, the code is considered invalid or incomplete if there are not seven characters in the code.  

If a code requires the reporting of a seventh character and there is no fifth or sixth character option, the use of the "X" placeholder may be required.  For example, when using the following code, there are no options for the fifth or sixth character:

S02.2XXK Fracture of nasal bones, subsequent encounter for fracture with nonunion

The next code has a fifth character but not a sixth, therefore the "X" place holder should be used. 

S02.30XG Fracture of orbital floor, unspecified side, subsequent encounter for fracture with delayed healing

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Artificial Intelligence in Healthcare - A Medical Coder's Perspective
December 26th, 2023 - Aimee Wilcox
We constantly hear how AI is creeping into every aspect of healthcare but what does that mean for medical coders and how can we better understand the language used in the codeset? Will AI take my place or will I learn with it and become an integral part of the process that uses AI to enhance my abilities? 
Specialization: Your Advantage as a Medical Coding Contractor
December 22nd, 2023 - Find-A-Code
Medical coding contractors offer a valuable service to healthcare providers who would rather outsource coding and billing rather than handling things in-house. Some contractors are better than others, but there is one thing they all have in common: the need to present some sort of value proposition in order to land new clients. As a contractor, your value proposition is the advantage you offer. And that advantage is specialization.
ICD-10-CM Coding of Chronic Obstructive Pulmonary Disease (COPD)
December 19th, 2023 - Aimee Wilcox
Chronic respiratory disease is on the top 10 chronic disease list published by the National Institutes of Health (NIH). Although it is a chronic condition, it may be stable for some time and then suddenly become exacerbated and even impacted by another acute respiratory illness, such as bronchitis, RSV, or COVID-19. Understanding the nuances associated with the condition and how to properly assign ICD-10-CM codes is beneficial.
Changes to COVID-19 Vaccines Strike Again
December 12th, 2023 - Aimee Wilcox
According to the FDA, CDC, and other alphabet soup entities, the old COVID-19 vaccines are no longer able to treat the variants experienced today so new vaccines have been given the emergency use authorization to take the place of the old vaccines. No sooner was the updated 2024 CPT codebook published when 50 of the codes in it were deleted, some of which were being newly added for 2024.
Updated ICD-10-CM Codes for Appendicitis
November 14th, 2023 - Aimee Wilcox
With approximately 250,000 cases of acute appendicitis diagnosed annually in the United States, coding updates were made to ensure high-specificity coding could be achieved when reporting these diagnoses. While appendicitis almost equally affects both men and women, the type of appendicitis varies, as dose the risk of infection, sepsis, and perforation.
COVID Vaccine Coding Changes as of November 1, 2023
October 26th, 2023 - Wyn Staheli
COVID vaccine changes due to the end of the PHE as of November 1, 2023 are addressed in this article.
Medicare Guidance Changes for E/M Services
October 11th, 2023 - Wyn Staheli
2023 brought quite a few changes to Evaluation and management (E/M) services. The significant revisions as noted in the CPT codebook were welcome changes to bring other E/M services more in line with the changes that took place with Office or Other Outpatient Services a few years ago. As part of CMS’ Medicare Learning Network, the “Evaluation and Management Services Guide” publication was finally updated as of August 2023 to include the changes that took place in 2023. If you take a look at the new publication (see references below),....



Home About Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2024 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association