Health Information Management

Understand the 'X' in ICD-10 coding

HIM Connection, December 7, 2010

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By Shannon E. McCall, RHIA, CCS, CCS-P, CPC, CPC-I, CEMC, CCDS

What does “x” represent in ICD-10? What seemed like a fairly straightforward question and answer in a recent HCPro ICD-10 Basics Boot Camp™ class I was teaching actually evolved into more of a tricky topic than I initially thought. And it caused me to ponder the following question: Why did the coding authorities decide to use the letter “x” as a placeholder, and as a category of codes, as well as a character in ICD-10-PCS codes? In other words, how is one to determine what the “x” means? Consider the following variety of meanings an “x” can have in an ICD-10 code: 
  • For ICD-10-CM code T48.5x1A, the “x” is a placeholder.
  • For code category X78.0, the X is the category of codes (X00–X99) and identifies intention of an injury, exposure, etc.
  • For ICD-10-PCS code 0HB0XZX, the first “X” identifies that the approach was external and the second “X” identifies the procedure was diagnostic.
The positioning of the “x” as well as the code set (CM or PCS) involved determines what it indicates in each circumstance, but this can be confusing for those learning the system. Certainly, learning a new code set will prove a challenge to coders, and having multiple meanings for a letter makes it even harder.
 
Editor’s note: McCall is director of coding and HIM at HCPro, Inc. This tip comes from HCPro’s ICD-10 Trainer blog. Click here to access this free resource.



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