Use of 7th character "A" Initial Encounter


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I recently passed my CPC exam and during studying I was prompted to question my understanding of the use 7th character "A"-Initial Encounter. When ICD10-CM was introduced, we were taught that "A" was used at the initial patient encounter, then "D"-in most cases-was appropriate for subsequent visits. However, the definition reads "....Examples of active treatment are: surgical treatment, emergency department encounter, and evaluation and continuing treatment by the same physician or a different physician." According to this definition, it would be appropriate to code using the "A" as the 7th character for services beyond the initial encounter as long as that patient is receiving active treatment. I may be overthinking this (as I sometimes do), but just wanted to be sure I am clear on this as I do code for injuries and subsequent care frequently. Any clarification would be appreciated.

Pam Brooks

True Blue
Local Chapter Officer
NAB Member
South Berwick, ME
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Early on, as we all tried to figure out ICD-10-CM, there was some confusion about the use of the seventh digits "A", "D" and "S". I even attended workshops where the information was incorrect. The education (and clarification) has been better lately, and examples have been provided.

"A" means active treatment---whether it takes one encounter or fifteen for the active treatment to progress to the healing stage. "D" is used for those encounters where the active treatment is completed and the patient is healing. The confusion earlier had to do with "initial encounter" and "subsequent encounter", which coders took to mean visits, when in fact it meant the stage of treatment provided and not the number of visits.