Health Information Management

Tip: Get to know the ICD-10-CM placeholder

APCs Insider, April 13, 2012

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Not every ICD-10-CM code with a seventh character has a sixth character—or even a fifth or fourth character for that matter.

This frequently occurs with poisonings and injuries. The letter "x” serves as a placeholder when a code contains fewer than six characters and a seventh character applies. The "x” also allows for future expansion of the codes.

When reporting ICD-10-CM codes, coders must add a placeholder so the seventh character is in the correct position. Without this placeholder to ensure characters appear in the correct positions, codes are invalid.

For example, a patient presents with an accidental poisoning by an antiallergic drug. For the initial encounter, coders should report ICD-10-CM code T45.0x1A. In this case, the x in the fifth position serves as a placeholder so that the sixth and seventh characters are in the correct position. If a coder inadvertently omits the placeholder, the resulting code would be T45.01A, which is invalid.

Coders should also note that an ICD-10-CM code can start with an X (i.e., codes X00-X99). For example, in code category X78.0, the X denotes the intention of an injury, exposure, etc. The X series of codes is part of Chapter 20: External Causes of Morbidity.

Note that the location of the X within a code matters. When x is in the fourth, fifth, and/or sixth character, it appears lowercase and is a placeholder. When X is at the beginning of the code, it is uppercase and indicates the chapter.

The tip is adapted from “ICD-10-CM coding: Start with the structure” in the April issue of Briefings on APCs.

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