“xxxA” – ICD-10-CM Placeholder Code X and 7th Character Extension

Recently, while reviewing terms people use to find CodingIntel I was surprised to find that people were searching for “xxxA.” At first, I was afraid searchers were looking for a different kind of site….or sight.

But searchers were looking for information about placeholder code X and 7^th character extension A. These are typically used on ICD-10-CM codes in Chapter 19, Injury, Poisoning, and Certain Other Consequences of External Causes and Chapter 20, External Causes of Morbidity. Let’s start with the 7^th character extender.

7^th Character Extender

There are three common ones (A, S, D) and more for fractures.

• A is used for active treatment
• D is for subsequent care
• S is for sequela, complications or conditions that arise as the direct result of a condition
• 7^th characters are also used for fetus identification and in the comascale

X is a placeholder code.

If a 7^th character is required, but the complete code is less than six characters, ICD-10-CM uses the letter x as a placeholder code to extend the code to six characters, allowing the 7^th character to be added.

Placeholder Code Examples

Unspecified fall, W19 is a complete code. Naturally, we don’t want to use an unspecified code, but if we had to use W19, we need to add a 7^th character. For active treatment, including the initial encounter, the complete code would be W19.xxxA.

X12 is the complete code for “contact with other hot fluids.” The initial encounter would be coded as X12.xxxA.

Would we put either of these codes in the first position on the claim form? Never! The injury is sequenced first.

I breathed a sigh of relief knowing that these xxxA searches weren’t x-rated (or x-rays, for that matter) but related to the placeholder code and 7^th character extension.

Sometimes coding is funny.

Looking for a list of codes that use placeholder xxx? We have it.

• Reference Sheet_Codes with placeholder XXX