Need someone to help me understand the 7th character ASAP

darmandahl

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When the admission/encounter is for management of an anemia associated with an adverse effect of the administration of chemotherapy or immunotherapy and the only treatment is for the anemia, the anemia code is sequenced first followed by the appropriate codes for the neoplasm and the adverse effect (T45.1X5, Adverse effect of antineoplastic and immunosuppressive drugs).

that is the guideline but I am not sure about the 7th character, I am thinking it stays A as the patient is still receiving chemo even though this visit is not for the chemo but for the adverse effect? please anyone am I correct in my understanding?
 
If this is the first encounter for treating the adverse effect (anemia), then I would code it A (initial encounter).
If a subsequent encounter for the anemia, then code D - subsequent.
 
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