All About Seventh Character “A”

All About Seventh Character “A”


This coding tip has to do with the seventh character “A” used in chapter 19 of the ICD-10-CM book. If you read the guidelines in Chapter 19 (Injury, Poisoning, and Certain Other Consequences of External Causes) you will see that the seventh character “A” means initial encounter and is used for each encounter where the patient is receiving active treatment for the condition.


The wording “initial encounter” can confuse coders who are not familiar with the guidelines. It does not mean that the “A” can only be used once for the first time a patient sees a doctor. The “A” means active treatment and can be used many times.


For example, say a person goes to the ER for a fall and an x-ray confirms a broken wrist. If you are coding this x ray, you would use the fracture code with the “A” for initial encounter because the patient is in active treatment for the fracture. Now say the patient returns home, but the next day goes to see his/her primary care doctor. If you are coding this encounter, you would still use the fracture code with the seventh character “A” for initial encounter because the patient is still in active treatment. Make a long story short, some coders might code that encounter with “D” for subsequent encounter but that is incorrect. Seventh character “D” is not used until the patient has completed active treatment of the condition and is receiving routine care during the healing or recovery phase.


Case in point-the seventh character “A” can be used many times because it means active care, not first encounter only.

Lindsay Della Vella BS, COC