Another discussion of codes that use placeholder xxxA (or xxx with another 7^th character)

One of the most searched terms on CodingIntel is xxxA. Experienced diagnosis coders recognize the placeholder digits “xxx” and the 7^th character extender A. When we pulled the list of ICD-10-CM codes that have xxxA in them, nine related to self-harm or assault. Of course, there are other diagnosis codes for these situations that use xxA or xA, depending on the number of digits in the code. The placeholder code is needed so that the 7^th character is in the 7^th position.

As with other external cause codes, these are never listed in the first position. The injury is always listed in the first position

The external cause code is sequenced after the specific injury.

In the case of self-harm or assault by a chemical or drug, start with the Table of Drugs and Chemicals. These substances are listed alphabetically, with six different headings. Not all drugs and chemicals have a code in all of the six headings. The headings are poisoning accidental, poisoning intentional self-harm, poisoning assault, poisoning undetermined, adverse effects and underdosing.

According to the Official Guidelines the correct method for coding these is to start with the Index to Diseases and injury. Chapter 19, “Injury, Poisoning, and Certain Other Consequences of External Causes (S00—T88)” is where injury diagnosis codes are found. Most categories in the chapter will require a seventh character extender. If the category or subcategory code that describes the injury is less than six characters, a placeholder code x, or xx or xxx will be needed so that the seventh character is in the seventh position. Although fracture codes have other options for seventh characters, most injuries use one of three 7^th characters.

A: initial encounter

D: subsequent encounter

S: sequela

Chapter 20 External Causes of Morbidity (V00—Y99)

The first sentence in the guidelines for Chapter 20 states “The external causes of morbidity codes should never be sequenced as the first-listed or principal diagnosis.” These codes provide information about how the injury or health condition happened, the intent, the place where the event occurred, and the patient activity when the injury occurred. In an inpatient setting, multiple external cause codes are likely to be used. In a physician practice, it is critical to report the injury and at least one external cause code.

Other placeholder articles

• “xxxA” – ICD-10-CM Placeholder Code X and 7th Character Extension
• Diagnosis coding for a fall (or other injury)