New Guidance on 7th Characters ‘A’ vs. ‘D’ in ICD-10-CM

7th Characters were a new concept introduced in the first issue of ICD-10-CM in October of 2015. Various chapters of ICD-10-CM use a 7th character for different reasons. For example, in the eye chapter, the 7th character is used to identify the stage of glaucoma, in the OB section a 7th character is used to identify which fetus is involved, and in injuries, a 7th character is used to identify stage of treatment.

Out of all of the 7th characters possible in these diagnoses (A, D, or S), the ‘A’ versus the ‘D’ have been contemplated and discussed the most by far. Our original ICD-10 Guidance from 2015 established the following:

7th character A is for use as long as the patient is receiving active treatment. Examples of active treatment are: surgical treatment, emergency department encounter, evaluation and treatment by a new physician.

A = Active

7th character D is to be used for encounters after the patient has completed active treatment.

D = Done

Many understood this concept to mean from a patient’s perspective, is there active treatment to the problem still occurring, or are the visits a follow up for routine care after the treatments have been completed.

There was an update on the use of the 7th Characters “A” and “D” in the new 2017 ICD-10-CM Guidelines effective October 1, 2016. The changes are presented in blue font below. Changes to the original text are underlined below.

Chapter 19: Injury, poisoning, and certain other consequences of external causes

  1. Application of 7th Characters in Chapter 19


7th character “A,” initial encounter is used for each encounter where the patient is receiving active treatment for the condition.

7th character “D” subsequent encounter is used for encounters after the patient has completed active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase.

This new guidance illustrates the intention of 7th Character “A” to be used for each encounter where the patient is receiving active treatment (not just the first encounter) and that the 7th Character “D” is intended for use once active treatment has been completed and the patient is obtaining routine care during the recovery or healing phase.

Brian Boyce, BSHS, CPC, CPC-I, CRC, CTPRP is an AAPC-approved PMCC medical coding instructor, and ICD-10-CM trainer and the author of the AAPC CRC® curriculum. He has specialized in risk adjustment from the very beginnings of these models being utilized and has assisted large and small clients nationally. He has special interest in ethics, patient safety, disease management, and management and leadership of people. Brian is a veteran of Desert Storm, where he served on active duty with the US Air Force with a job specialty of Aeromedical Evacuation. He went into physician practice management and medical coding after an honorable discharge. He is the CEO of ionHealthcare® LLC, a company that specializes in healthcare consulting, risk adjustment coding, management & support services. For additional inquiries contact ionHealthcare® at