Health Information Management

Tip: Prepare for coding challenges with seventh character in ICD-10-CM

APCs Insider, April 8, 2011

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Current ICD-9-CM codes are three to five characters in length. Valid ICD-10-CM codes range from three to seven characters:

  • Character one is alpha (all letters used except "U")
  • Character two is numeric
  • Characters three through seven are alpha or numeric

That seventh character may prove challenging, in part because it means different things in different chapters. For fractures, the seventh character denotes initial encounter, subsequent encounter, or sequelae; the type of fracture (e.g., open or closed); or the type of healing (e.g., routine, delayed, malunion, or nonunion).

Documentation often already specifies which limb and side of the body is involved. However, it may not include the additional information necessary to assign a seventh character under ICD-10-CM.

The tip is adapted from “Coming soon to an ED near you: ICD-10-” in the April issue of Briefings on APCs.

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