Clarifying ICD-10 Seventh Digits

Most coding literature identifies the ICD-10 seventh digit codes of A and D as “Initial” and “Subsequent” respec- tively. However, their full definitions are more detailed. More accurate definitions would be “active treatment” for A and “follow up treatment” for D.

For example, when treating a fracture, if you perform in initial visit and an x-ray on one day, then a surgery a week later, both of these encounters should be coded with “A” as your seventh digit. Follow up encounters in- cluding x-rays to check healing, suture or cast removal, physical therapy, and post-operative visits should be coded with “D” as the seventh digit.

Continue to use “S” for a sequela situation. For example, if a subsequent condition related to the fracture aris- es, say swelling, make swelling your primary diagnosis and the fracture with seventh digit “S” as the secondary diagnosis.