I would use the A as the 7th character given the definitions below from the ICD-10 coding guidelines.
Extension “A”, initial encounter is used while the patient is receiving active treatment for the injury. Examples of active treatment are: surgical treatment, emergency department encounter, and evaluation and treatment by a new physician.
Extension “D” subsequent encounter is used for encounters after the patient has received active treatment of the injury and is receiving routine care for the injury during the healing or recovery phase. Examples of subsequent care are: cast change or removal, removal of external of internal fixation device, medication adjustment, other aftercare and follow up visits following injury treatment.
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