ICD-10 Spotlight: Know the codes (7th character extension for episode of care)

May 1, 2012

Each month, IBC will feature an example of how ICD-9 codes will translate to ICD-10 codes. We will present coding examples from different specialties and popular disease categories to demonstrate the granularity that the new ICD-10 code set will provide.

Coding convention: Seventh character extension

One example of how ICD-10 codes differ from ICD-9 codes is the addition of a seventh character extension in the coding structure. The seventh character extension in ICD-10 codes is primarily used to document the episode of care for fractures, injuries, poisonings, other consequences of external causes, and conditions that affect a fetus at multiple gestations. The designation of the seventh character extension in ICD-10 conveys greater specificity and clinical detail. For injuries, poisonings, and other consequences of external causes, the seventh character designates the episode of care as: A = Initial Encounter D = Subsequent Encounter S = Sequela Condition Clinical documentation ICD-10 code Injury Superficial foreign body of unspecified shoulder, initial encounter S40.259A Poisoning Poisoning by penicillins, accidental (unintentional), subsequent encounter T36.0x1D* Consequences of external causes Adverse effect of benzodiazepines, sequela T42.4x5S*

Note: Fractures are not included in these examples due to the complexity of assigning seventh characters for episode of care.

For conditions that affect a fetus, the seventh character designates certain complications of pregnancy at multiple gestations to denote which fetus is affected: 0 = not applicable or unspecified 1 = fetus 1 2 = fetus 2 3 = fetus 3 4 = fetus 4 5 = fetus 5 9 = other fetus Condition Clinical documentation ICD-10 code Maternal care for breech presentation, fetus 1 O32.1xx1* Maternal care for (suspected) central nervous system malformation in fetus, fetus 2 O35.0xx2* Maternal care for anti-D [Rh] antibodies, second trimester, fetus 3 O36.0123 Polyhydramnios, third trimester, fetus 4 O40.3xx4* Infection of amniotic sac and membranes, unspecified, second trimester, fetus 5 O41.1025 Complication of pregnancy affecting fetus Labor and delivery complicated by cord around neck, with compression, other fetus O69.1xx9*

*For codes that include only three to five characters, ?x? is used to fill in empty character fields.

For additional information related to IBC?s transition to ICD-10, please refer to the ICD-10 section of our website.