January 25, 2011 | | Comments 0
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‘X’ marks the spot, but for what?

When coders are looking at scenarios in ICD-10-CM/PCS, where the X is located within the code matters.

When X is in the fifth and/or sixth character, X is a placeholder. ICD-10-CM codes can be up to seven characters long. However, not every code that requires a seventh character is actually seven characters long. So some codes do not have an applicable fifth digit. Some lack a fifth and a sixth character. In those cases, such as poisonings or injuries, coders will need to add a placeholder so the seventh character ends up in the correct position. Otherwise, the code will be invalid.

For example, a patient presents with an accidental poisoning by other anti-common-cold drugs. For the initial encounter, coders would report T48.5x1A. In this case the x is merely a placeholder so the sixth and seventh characters are in the correct position. If a coder inadvertently omits the placeholder, code T48.51A is not a valid code.

When X is at the beginning of the code, it indicates the chapter (i.e., codes X00–X99). For code category X78.0, the X is the category of codes and identifies intention of an injury, exposure, etc. The X series of codes is part of Chapter 20: External causes of morbidity.

The character X can be even more confusing to coders who work with both inpatient and outpatient records. In ICD-10-PCS, X can be used in multiple places, each with a different meaning. For example, in ICD-10-PCS code 0HB0XZX, the first X identifies that the approach was external and the second X identifies the procedure was diagnostic.

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Filed Under: Coding


Michelle A. Leppert About the Author: Michelle A. Leppert, CPC, is a senior managing editor for JustCoding.com. JustCoding provides coders, coding supervisors, and health information management (HIM) directors with educational resources to test their coding knowledge, employ correct coding guidelines, and stay abreast of CMS transmittals.

In addition, she writes and edits the HCPro publication, Briefings on Coding Compliance Strategies. Email her at mleppert@hcpro.com.

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