Various chapters of ICD-10-CM use a 7th character for different reasons. For example, in the eye chapter, the 7th character is used to identify the stage of glaucoma, in the OB section a 7th character is used to identify which fetus is involved, and in injuries, a 7th character is used to identify stage of treatment.
Do not apply a 7th character code where one is not required. There are 7th character codes located in Chapters 7, 13, 15, 18, 19, and 20, which report various details spanning across many specialties, but not all codes in ICD-10-CM require a 7th character. If a 7th character is applied where it doesn't belong, the claim will be denied.
The ICD-1o 7th character is only required when the ICD-10 rules specifically ask for the 7th character and give you a choice as to which of several characters to use.
For injuries, poisonings, and other consequences of external causes covered under Chapter 19, the 7th character extension captures information about the type of clinical encounter. The episode of care is designated by the 7th character and specifies the visit as initial, subsequent, or sequela.
The seventh character is a qualifier that may have a specific meaning for a limited range of values. For example, the qualifier can be used to identify the destination site of the root operation Bypass.
0The seventh character of "0" is assigned as follows: For single gestation. When the documentation in the record is insufficient to determine the fetus affected and it is not possible to obtain clarification. When it is not possible to clinically determine which fetus is affected.
Use 7th character S, sequela, “for complications or conditions that arise as a direct result of a condition, such as scar formation after a burn.
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.
When coding pregnancy-related diagnoses, ICD-10 often requires a 7th character (the highest specificity for the system). With codes describing pregnancy condititions related to multiple gestation, the 7th digit specifies the number of fetuses in utero.
If the condition developed prior to the current admission/encounter or represents a pre- existing condition, the trimester character for the trimester at the time of the admission/encounter should be assigned. Each category that includes codes for trimester has a code for “unspecified trimester.”
The length of ICD-10-CM diagnosis codes can range from four to seven characters; however, instructions indi- cate that when a 7th character is to be used it must be positioned as the 7th character. If a code has less than six characters, then one or more placeholders must be insert- ed before the 7th character.
The 7th character represents the type of encounter, or phase of treatment; this could be an initial encounter, a subsequent encounter, or a sequela (previously known as a late effect).
The seventh character is an extension, primarily used to document episode of care for injuries and other conditions with external causes. There are several characters that can go here: A: Initial encounter (the active phase of treatment)
The seventh characters available for these open fractures are: 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.
7th character “A”, initial encounter is used for each encounter where the patient is receiving active treatment for the condition.
7th character “D” is the subsequent encounter and is used for encounters after the patient has received active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase.
Use 7 th character D, subsequent encounter, “for encounters after the patient has completed active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase.” When a code has an option for a subsequent encounter 7 th character, you should use that character instead of reporting an aftercare Z code.
Use 7 th character S, sequela, “for complications or conditions that arise as a direct result of a condition, such as scar formation after a burn. The scars are sequelae of the burn.” You should first report a code for the sequela (like the scar) and then report the injury code with 7 th character S.
ICD-10-CM uses the placeholder character X in certain codes. You’ll see this in cases where a code requires a later character in a certain position, but the code does not have specific characters for one or more places before that character. By using a placeholder, the ICD-10-CM code set gives itself room to expand later.
For PT/OT, a 7th character is typically only required in the case of injuries. The most common 7th characters are A, D , and S.
If you need to use the S 7th character, use both the injury/condition code that precipitated the sequela and the code for the sequela itself. Add the S only to the injury code, not the sequela code. The S identifies the injury or condition responsible for the sequela.
However, if you are treating a direct access patient who has not seen a physician or another provider first and you are providing active treatment for the injury, you would use the A 7th character for active treatment of the injury and generally the D character for follow-up visits during the healing/recovery phase.
D=Subsequent encounter which is for encounters after the patient has received active treatment for the injury/condition and is receiving routine care during the healing or recovery phase. Most PT/OT, including your initial eval, is regarded as a subsequent encounter during an episode of care. So, for the vast majority of PT/OT care requiring a 7th character, you should use D.
Therapists will typically not use the A character because most of your patients have first been seen by a physician or other provider.
Keep in mind that Medicare has adopted a policy under which it will not deny your claim if your 7th character is wrong or even if you leave off the 7th character; however, other payers have not formally adopted a similar policy. icd-10 7th character, icd-10 rules, medicare and icd-10 7th character.
The 7th character extension must occupy the 7th data field, and if the preceding code has fewer than six characters, a dummy placeholder X is used to fill empty fields so that the 7th character can assume its correct position.
The 7th digit was added to some codes in ICD-10-CM to provide additional information. The details that are captured by this 7th character extension were not previously recorded when the ICD-9-CM codes were in use. ICD-9-CM codes were 3-5 digit codes while the ICD-10-CM codes can be up to 7 characters long. There can be no direct one-to-one mapping between the new and old code sets since the 7th character did not exist in ICD-9-CM.
There is no 7th character for "not otherwise specified.". If a fracture is not specified as open or closed, it is assumed to be closed. The physician should provide detailed information about the open/closed nature of the fracture and the appropriate Gustilo classification to allow the diagnosis to be correctly coded.
Without the 7th digit, the ICD-9-CM code set did not capture the degree of specificity that can now be recorded with ICD-10-CM. The older code set did not provide a mechanism to capture the details that are now recorded by the 7th character. This extra level of detail can only be recorded with the 7th character extension in ICD-10-CM.
The number of codes has risen dramatically from 13,000 codes in ICD-9-CM to over 68,000 codes in the new code set. ICD-10-CM has some new features that provide greater specificity compared to ICD-9-CM. In part, this specificity is accomplished by assigning the 7th character, also referred to as the 7th character extension, to some codes in ICD-10-CM. The 7th character is one of the most significant differences between the two code sets.
Characteristics of ICD-10-CM codes: - Alphanumeric and up to 7 characters in length - The first character is always alphabetic - The second character is always numeric - The remaining five digits are a combination of alphabetic and numeric - All codes require a decimal after the third character - If laterality is required in a code, it must be included to make the code valid - Characters 1-3 indicate the category of diagnosis - Characters 4-6 indicate etiology, anatomic site, severity, and other clinical details - The 7th character indicates the type of encounter, type of fracture, or some other vital information
When the patient is receiving active treatment for an injury, the initial encounter "A" seventh character extension is used in the 7th data field of the code. " Initial encounter " can be misleading; in fact, it does not necessarily have to be the patient's first visit. As long as the patient is receiving active treatment, the 7th character value will remain "A." This includes surgical treatment, emergency department encounters, and initial assessment and treatment by a physician.
The point to be noted is that the initial and subsequent encounters are talking about the diagnosis of same person which can save up his medical history and records.
Though the health information sharing has a lot of regulatory restrictions in the USA from acts like HIPPA (Health Insurance Portability and Accountability Act), ICD is in accordance with the act. It also helps resolve disputes related to claim settlements by identifying the root cause if death.
ICD stands for International Classification of Disease, a technological innovation that helps to spot health trends, statistics and new diseases globally. A lot of diseases and symptoms classification has been done by ICD. It has been in operation since May 1990.
S represents a Sequela, this is the condition where the patient has developed some complications because of the injury or disease. Many a times an injury does not point towards any further damage to the cells or blood flow but, in the later stages it may develop haemorrhage or something similar to that.
ICD-9-CM, 'aftercare' codes have been replaced by 7th character codes in ICD-10-CM. The 7th characters identify active treatment, healing phase, and sequale (all healed up but the patient's new problem was caused by the old one).
When the active treatment is determined as complete by the provider who managed it, the remaining care during the healing phase is reported with 7th character 'D'.
Emergency department services for initial care of the condition or complications
As auditors, we tend to focus heavily on proper procedure and Evaluation and Management code reporting; however, accurate ICD-10-CM reporting needs our attention as well. Claims are being denied regularly for incorrect diagnosis code reporting, which can and will cause revenue issues. With the code freeze removed and the one-year grace period ending, we are likely to see even more denials based on inaccurate ICD-10-CM reporting. Identifying the more prevalent ICD-10-CM issues now and providing training on them will promote quality coding and accurate reimbursement.
Keep your critical coding and billing tools with you no matter where you work.
Do not apply a 7th character code where one is not required. There are 7th character codes located in Chapters 7, 13, 15, 18, 19, and 20, which report various details spanning across many specialties, but not all codes in ICD-10-CM require a 7th character. If a 7th character is applied where it doesn't belong, the claim will be denied.
For example, in the eye chapter, the 7th character is used to identify the stage of glaucoma, in the OB section a 7th character is used to identify which fetus is involved, and in injuries, a 7th character is used to identify stage of treatment.
This new guidance illustrates the intention of 7 th Character “A” to be used for each encounter where the patient is receiving active treatment (not just the first encounter) and that the 7 th Character “D” is intended for use once active treatment has been completed and the patient is obtaining routine care during the recovery or healing phase.
7th character “A,” initial encounter is used for each encounter where the patient is receiving active treatment for the condition.
7th character D is to be used for encounters after the patient has completed active treatment.
Remember 7th character extensions also are required for some pregnancy complication codes. In that case, the 7th character indicates which fetus is affected.
The 7th character is used to indicate the episode of care. Generally, the following three options are available as 7th character extensions:
All three providers would code the ankle fracture using the 7th character ‘A’ because the patient is still receiving active treatment for the fracture.”
While the implementation of ICD-10 has gone “so far so good,” according to ICD-10 Monitor, some small coding issues have begun to arise, including the 7th character selections for injury, poisonings, and other trauma.
For instance, an encounter is not an indicator of how many times the patient has received the same injury. “It’s perhaps too common for someone to read that ‘subsequent encounter’ part of the diagnosis and wonder how many times a patient could run into a lamppost, get sucked into a jet engine or get bit by a macaw,” writes Carl Natale at ICD-10 Watch. “So it’s worth reminding everyone that the encounter describes the patient seeing a clinician not a second injury.”