7th Character Assignment for Injuries

Posted by: Nancy Lindberg, RHIT, CCS at Sep 16, 2022

Is your facility or client missing out on correct payment due to inaccurate 7th Character Assignment for Injuries? The difference between “Sequela” and “Initial” encounter can result in underpayment to the facility.

Determining the 7th Character assignment is based on the documented events found the medical record. It is important to review all pertinent notes that provide clues regarding the stage of treatment for the injury. According ICD-10-CM Official Guidelines for Coding and Reporting; Section I. Chapter 19.a. Application of 7th Character assignment:

• 7th character “A”, initial encounter is used for each encounter where the patient is receiving active treatment for the condition. Examples of active treatment include: Surgical treatment such as fracture reduction; ED encounter for laceration repair; or Evaluation and continued treatment by the same or different physician.
• 7th character “D” subsequent encounter is used for encounters after the patient has completed active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase. The aftercare Z codes should not be used for aftercare for conditions such as injuries or poisonings, where 7th characters are provided to identify subsequent care. For example, for aftercare of an injury, assign the acute injury code with the 7th character “D” (subsequent encounter). Examples of subsequent encounters: Cast changes/removals; Removal of internal or external fixation devices after fracture has healed; Medication adjustments; Follow-up visits; X-ray to check on status of healing fracture; or ED visit for suture removal.
• 7th character “S”, sequela, is for use for complications or conditions that arise as a direct result of a condition, such as scar formation after a burn. The scars are sequelae of the burn. The 7th character “S” identifies the injury responsible for the sequela. The specific type of sequela (e.g. scar) is sequenced first, followed by the injury code.

Nancy Lindberg, RHIT, CCS
Manager, Consulting Services
LexiCode, an Exela Technologies Brand