Using the X Place holder is not optional. Be sure you understand how to use it. If the code you are using requires a the Character such as the A - initial encounter, D - subsequent encounter or S- sequela, you understand the "X" Place holder. Not all Codes requiring a 7th character will have a 4th, 5th, or possibly even a 6th code.
This can be seen more often in the S-T sections for Injuries and Poisonings, and are also used with accidents. The "X" Place holder can be used anywhere in the code to make a complete code for example: X00.0XXA "Exposure to flames in uncontrolled fire in bldg, initial."
The letter X is used where there are no other characters available and you are required to have 7 characters. If not coded correctly, your claim will be denied. The "x” also allows for future expansion of the codes.
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