Understanding and Clarification of the ICD-10 7th Digit Encounter Character
There has been a lot of discussion about the interpretation of the 7th digit “encounter” code, specifically when to use the “A” Initial, “D” Subsequent, and “S” Sequela. We hope this helps to clear up the understanding of this.
Seventh character extensions for injuries include:
A – Initial encounter. This describes the entire period in which a patient is receiving active treatment for the injury, poisoning, or other consequences of an external cause. So, you can use “A” as the seventh character on more than just the first claim. In fact, you can use it on multiple claims.
D – Subsequent encounter. This describes any encounter after the active phase of treatment, when the patient is receiving routine care for the injury during the period of healing or recovery. (This generally includes rehabilitation therapy.) If a physician referred the patient to a physical therapist for rehabilitation of the patient’s strained Achilles tendon. Rehab therapy would be considered part of the healing and recovery phase, so you would code for “subsequent encounter,” thus assigning the seventh character “D.”
S – Sequela. The seventh character extension “S” indicates a complication or condition that arises as a direct result of an injury. An example of a sequela is a scar resulting from a burn.
(reference “Understanding the ICD-10 Code Structure”, WebPT)