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ICD-10-CM 7th Character and its use

By:  Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
Published:  May 6th, 2015

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




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