by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
May 6th, 2015 - Reviewed/Updated Aug 8th
The 7th character is used in certain chapters (e.g., Obstetrics, Injury, Musculoskeletal, and External Cause chapters). However, it is not used in every chapter and may have a different meaning depending on the section where it is being used. One thing that is consistent, is that it must be used in the 7th character position (using the x place holder if necessary). When a 7th character applies and it is not used, the code is considered invalid.
Use of 7th Characters by Chapter
- Obstetric
Multiple gestations – identification of fetus affected by condition
- Injury
Type of encounter
Closed vs. open fracture
Routine vs. delayed healing
Malunion or nonunion of fracture
- Musculoskeletal
Type of encounter
Routine vs. delayed healing
Malunion or nonunion of fracture
Additional clinical information
- External Cause
Type of encounter
7th Character Describing Encounter
- Initial encounter: As long as patient is receiving active treatment for the condition.
- Subsequent encounter: After patient has received active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase.
- Sequela: Complications or conditions that arise as a direct result of a condition (e.g., scar formation after a burn).
Note: For aftercare of injury, assign acute injury code with 7th character for subsequent encounter.
7th Character – Fractures
A Initial encounter for closed fracture
B Initial encounter for open fracture
D Subsequent encounter for fracture with routine healing
G Subsequent encounter for fracture with delayed healing
K Subsequent encounter for fracture with nonunion
P Subsequent encounter for fracture with malunion
S Sequela
References/Resources
About Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
Christine Woolstenhulme, CPC, QCC, CMCS, CMRS, is a Certified coder and Medical Biller currently employed with Find-A-Code. Bringing over 30 years of insight, business knowledge, and innovation to the healthcare industry. Establishing a successful Medical Billing Company from 1994 to 2015, during this time, Christine has had the opportunity to learn all aspects of revenue cycle management while working with independent practitioners and in clinic settings. Christine was a VAR for AltaPoint EHR software sales, along with management positions and medical practice consulting. Understanding the complete patient engagement cycle and developing efficient processes to coordinate teams ensuring best practice standards in healthcare. Working with payers on coding and interpreting ACA policies according to state benchmarks and insurance filings and implementing company procedures and policies to coordinate teams and payer benefits.