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

July 27th, 2017 - Chris Woolstenhulme, CPC, CMRS
Categories:   Coding  
0 Votes - Sign in to vote or comment.

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)

How to Search Find-A-Code for Medicare Policies and Guidelines — LCDs, NCDs and Articles —
November 18th, 2020 - Raquel Shumway
Help for Searching Find-A-Code when searching for Medicare Policies and Guidelines — LCDs, NCDs and/or Articles.
Cross-A-Code Instructions in Find-A-Code
November 18th, 2020 - Raquel Shumway
Cross-A-Codeis a toll found in Find-A-Code which helps you to locate codes in other code sets that help you when submitting a claim.
COVID Vaccine Codes Announced
November 11th, 2020 - Wyn Staheli, Director of Research
On November 10, 2020, the American Medical Association (AMA) announced the addition of two new codes which will be used for the new COVID-19 vaccines along with 4 new administration codes to be used when reporting the administration of these vaccines.
Are You Aware of the 2021 Star Rating System Updates?
November 5th, 2020 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
Each year the Centers for Medicare & Medicaid Services (CMS) publishes the Star Ratings System Updates for Medicare Advantage (Part C) and Medicare Prescription (Part D). This rating system was developed to help beneficiaries identify and select the health plans that best meet their needs, specifically addressing main issues:  Quality of ...
Special Needs Plans Help Beneficiaries and Risk Adjustment Reporting
October 22nd, 2020 - Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content
It is no secret that Medicare and Medicaid are steadily moving towards their goal of value-based health care. Medicare Part C (Medicare Advantage) identifies and rewards payers, and subsequently their providers, for increasing the efficiency and quality of care they provide to Medicare...
CMS Expands Telehealth Again
October 20th, 2020 - Wyn Staheli, Director of Research
On October 14, 2020, CMS announced further changes to expand telehealth coverage. Eleven (11) new codes have been added to their list of covered services bringing the current total to 144 services. The new services include some neurostimulator analysis and programming services as well as some cardiac and pulmonary rehabilitation services.
Significant COVID-19 Code Changes as of October 6
October 8th, 2020 - Wyn Staheli, Director of Research
Significan COVID-19 Code Changes as of October 6



Home About Contact Terms Privacy

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

Copyright © 2000-2020 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association