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ICD-10 Articles: Coding Corner

Seventh Character Extension for Episode of Care

A notable difference between ICD-9-CM and ICD-10-CM is the addition of a seventh character to certain ICD-10 diagnosis codes. The seventh character extension allows greater specificity and clinical detail. This character always resides in the seventh position of the code.

One type of seventh character extension is used to identify episode of care. Episode of care seventh characters are used primarily for injuries, poisoning and other consequences of external causes.

This concept can be found in some of the ICD-10-CM codes located in the following chapters:

  • Chapter 13 - Diseases of Musculoskeletal system and connective tissue
  • Chapter 19 - Injury, poisoning and certain and other consequences of external causes
  • Chapter 20 - External Causes of morbidity

The seventh character episodes of care are:

  • A = Initial Encounter
    While the patient is receiving active treatment for the condition
  • D = Subsequent Encounter
    Encounters after the patient has received active treatment of the condition and is receiving routine care for the condition during the healing and recovery phase
  • S = Sequela
    Complications or conditions that arise as a direct result of a condition

ICD-10 codes are invalid if they have not been coded to the full number of characters required for that code, including the seventh character, if applicable.