How to Assign the 7th Character in ICD-10

• Erin Hebert

How to Assign the 7th Character in ICD-10

This month we will discuss 7th characters A and D. Updated coding guidelines tell us that assignment of the 7th character is based on whether the patient is receiving active treatment. “Initial encounter” or 7th character A is now used if the patient is receiving active treatment for the condition. In other words, disregard the word “initial” when assigning the 7th character A. “Subsequent Encounter,” or 7th character D, should be used after the patient received active treatment and is now requiring routine care.

Some examples of active treatment that will require a 7th character A include:

Malunions/nonunions when the patient delayed seeking treatment for the fracture, antibiotic therapy for a postop infection, and wound dehiscence requiring wound vac.

Examples of subsequent encounter that will require a 7th character D include:

Routine care of a healing fracture, other aftercare and follow-up after treatment of an injury or condition, suture removal and routine dressing changes.

Let’s look at a scenario for 7th character A:

Patient is admitted to home health for infection of right hip joint prosthesis and will be receiving IV antibiotics for 6 weeks.

T84.51XA Infection and inflammatory reaction due to internal right hip prosthesis, initial encounter

The antibiotic treatment is considered active treatment.

Scenario for 7th character D:

The patient is requiring physical therapy following a right hip fracture repair. There were no postop complications.

S72.001D Fracture of unspecified part of neck of right femur, subsequent encounter for closed fracture with routine healing

Erin Hebert, RN, BSN, HCS-D, COS-C

Assistant Director of Coding & OASIS Review

Erin joined the coding department after working in the medical telemetry and outpatient surgery units. A native of the Mississippi Gulf Coast, Erin holds a chemistry degree from Ole Miss and a nursing degree from the University of Southern Mississippi. Erin enjoys practicing the violin with her daughter, spending time with her husband and son and taking long walks on the beach.