In ICD-10-CM, the 7th character adds detail about the encounter or the healing stage, such as A for initial encounter, D for subsequent encounter, and S for sequela. The placeholder X fills empty positions so the 7th character always sits in the seventh spot, as in S00.91XA.
What Is the 7th Character in ICD-10-CM?
The 7th character is required for certain categories, mainly injuries and external causes in Chapter 19, fractures, and some obstetric codes. A code that requires a 7th character is invalid without it. Initial encounter means the patient is receiving active treatment, not simply that it is the first visit (ICD-10-CM Guideline I.C.19.a).
7th Character Values for Injuries
- A: Initial encounter (active treatment)
- D: Subsequent encounter (routine healing or recovery phase)
- S: Sequela (complications or conditions that result directly from the injury)
7th Character Values for Fractures
Fracture categories use expanded values, and the available values differ by category, so always check the Tabular List. For example, category S52 (fracture of forearm) uses the following:
| Value | Meaning |
|---|---|
| A | Initial encounter for closed fracture |
| B | Initial encounter for open fracture type I or II |
| C | Initial encounter for open fracture type IIIA, IIIB, or IIIC |
| D | Subsequent encounter for closed fracture with routine healing |
| 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 |
| G | Subsequent encounter for closed fracture with delayed 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 |
| K | Subsequent encounter for closed fracture with nonunion |
| 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 |
| P | Subsequent encounter for closed fracture with malunion |
| 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 |
| S | Sequela |
For more fracture scenarios, see our ICD-10 fracture coding guide.
What Is the Placeholder X?
The X is a placeholder character. It is used when a code requires a 7th character but has fewer than six characters, so the 7th character still lands in position seven. It also appears in certain categories, such as poisoning codes, to hold a position for future expansion (ICD-10-CM Guideline I.A.4). Use X only where the Tabular List shows it.
Examples of the 7th Character and Placeholder X
- S52.501A: Unspecified fracture of the lower end of right radius, initial encounter for closed fracture. No placeholder is needed because the code already has six characters.
- S00.91XA: Abrasion of unspecified part of head, initial encounter. S00.91 has only five characters, so X fills position six.
- T42.3X1A: Poisoning by barbiturates, accidental (unintentional), initial encounter. X holds position five.
Common 7th Character Mistakes
- Leaving off a required 7th character, which makes the code invalid
- Dropping the X and shifting the 7th character into position six
- Assigning A to every first visit instead of to active treatment
- Assigning D while the patient is still receiving active treatment
To practice building complete codes step by step, review the steps for ICD-10-CM coding.
Frequently Asked Questions
Is an ICD-10-CM code valid without its required 7th character?
No. A code that requires a 7th character is invalid without it, and the claim will be rejected.
Does initial encounter mean the first visit?
No. Initial encounter means the patient is receiving active treatment, which can span more than one visit.
When do I use the S (sequela) 7th character?
Use S for complications or conditions that arise as a direct result of an injury. Code the resulting condition first, followed by the injury code with S.
Can the placeholder X be used anywhere in a code?
No. Use X only where the Tabular List shows it as a placeholder.
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