ICD-10 7th Character: A vs D

September 30, 2015
Rick Gawenda

One of the most common two questions I receive is when a 7th character is required on an ICD-10 code, how do I know if the 7th character should be the character “A” or character “D”? Also, since I am doing an initial evaluation, shouldn’t the 7th character always be an “A” on that first visit and then change to character “D” for follow up visits? The answer to the second question is “not necessarily”. The use of the 7th character, in my opinion, is one of the most confusing for physical and occupational therapists as well as speech-language pathologists to understand. Below, I will try to answer the above 2 questions.

Lets start with the second question first and as I answer the second question, the first question will also be answered. If the reason for therapy is a result of an injury and the ICD-10 code requires a 7th character, should the initial visit for therapy have the 7th character as an “A”? The answer to this question is

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  1. What about the “S” 7th character? We have a patient that had an ACL traumatic tear about a 9 months ago that was surgically treated. We did therapy for her, she was discharged but is now returning for therapy on it again. No surgery this time,but having pain and muscle weakness with it. We would then use the S?
    Thank you,
    Heather Pierce

    1. I will be having an article come out about 7th character this week with an example. You can also look at the ICD-10 FAQs and 7th characters A, D and S.