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The Seventh Character’s Relevance – A, D & S in ICD-10

Start listing the major differences in the codes of ICD-9 and ICD-10 and this will probably the first on your list – the addition of seventh character extender.  This seventh character, in a way, is what ICD-10 is all about.  The tabular list of codes primarily listed in chapter 15 and 19, give you a detailed idea about why the number 7 is not so lucky in this case.  Let’s see how the 7th character plays it’s role.  If you need additional assistance, subscribing to MedConverge’s CodeAssist Service will provide you access to our ICD-10 Resource Hub as well!

A – Initial Encounter

‘A’ signifies that the patient is receiving treatment for the particular diagnosis for the first time. The confusion is faced when the patient visits the clinic for the continued treatment of the same diagnosis.  No matter how many visits the patient makes for the initial treatments of the same diagnosis, it will be coded with the extension ‘A’.

For example, if a surgery is to be conducted on the 3rd day after the diagnosis, the surgeon will still need to code it with the extender ‘A’, since the surgery is a part of initial treatment itself.

D – Subsequent Encounter

Once the initial treatment of the diagnosis is over, the patient may need to visit the clinic for a routine follow up.  In that case, the following treatment will be coded ‘D’.

S – Sequela

Sequela, characterized with letter, ‘S’ is used when a complication is faced due to a past injury, for example; a scar as a result of a burn or chronic pain as a result of a healed back injury.

 X – The Placeholder

Though not a part of seventh character extenders, the character ‘X’ plays a vital role in coding where the seventh code is required.  When the code is less than 6 characters long and still requires a seventh code extender, that is where the character ‘X’ come into play.

For example, code – T79. 6XXA is for Traumatic ischemia of muscle, initial encounter.

Here the code for Volkmann’s contracture consists of only 4 characters; whereas it needs the seventh character ‘A’ to mention that it is an initial evaluation of contracture, constituting active treatment.  The character ‘X’ is used as a place holder for 5th and 6th position.

The seventh character codes can be complicated – one needs to use them carefully.  Specific and accurate coding is very essential for the seventh character since it can be easily mixed up with and can hamper your claim.

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