# ICD-10 Digits



## kwhite2008 (Aug 21, 2013)

Hello- I am part of the ICD-10 project team for our organization and after a presentation, one of the physicians on the team asked if certain alpha digits are always going to mean the same thing for example: R for replacement. As I tried to look into this further for him, I am seeing a pattern that after the period, the 4th and 5th characters are always numbers, sometimes the 6th is as well but if the code requires a 7th digit, you would use x for the placeholder and the 7th digits vary by chapter of if they are a number or a letter but tend to stay consistent. Is the pattern that I think I am seeing correct? 
Thanks!

Kim, CPC


----------



## hundfam@aol.com (Aug 21, 2013)

Hi,
The first 3 characters categories (also known as blocks) each represent a single condition or disease. The 4th characters provide a higher level of specificity. For example;
C15 malignant neoplasm of esophagus
      C15.3 malignant neoplasm of esophagus of the upper third of esophagus
The 5th and 6th characters gives more information about the disease or condition. Example;
K50 Crohn's disease
K50.0 Crohn's disease of small intestine 
k50.01 Crohn's disease of small intestine without complications
K50.011 Crohn's disease of small intestine with rectal bleeding

The 7th digit is used mostly for injuries and poisoning. the letters A(for initial encounter), D (subsequent encounter) and S(sequela). For OB, the 7th is used to identify the which fetus, 0-9. The x or dummy placeholder, is used when a 5th or 6th digit is not available. Examples;
S50.311A abrasion of right elbow, initial encounter
O33.5xx0 maternal care for disproportion due to unusually large fetus, unspecified

Not sure where the doc got "R for replacement" but each chapter begins with a letters ranging from A00-Z99. Also, each code will guide you to check for additional digits. Just finished a class, hope this helps. Laura, CPC


----------



## mitchellde (Aug 21, 2013)

ICD-10 Uses Alpha numeric characters.
The first character is always a letter A-Z with the exception of U
The second character is always a Number 0-9
Characters 3-7 can be either a number or a letter (M1A.- or O9A.- , or S82.-)
The first 3 characters define the category, the decimal is there to remind you that characters 4-7 are an extension of the category.
Not all codes are 7 characters and not all 7th characters are A, D, or S.  Some are numbers such as the 7th characters for the coma scale.
each place after the decimal has a meaning for the category such as
T23 is the category for burn or wrist and hand
the fourth character represents the degree of burn
the 5th character represents the specific site of the hand
the 6th character represents the laterality 
the 7th character represents which encounter this is
so for a third degree burn of multiple sites of the left hand the initial encounter
T23.392A
For the poisonins
6th character matches up to the 6 columns in the table of drugs and chemicals, some of the codes have a 5th character and some do not so there is a placeholder x for those that do not have that specific characteristic
so adverse effect of penicillin initial encounter: T36.0x5A
And some codes need multiple placeholders such as bitten by dog
which has no valid 5th or 6th character but a required 7th for which encounter it is
W54.0xxA
or contact with broken glass which has no 4th, 5th, or 6th but a mandatory 7th
W25.xxxA
As far as the R goes, R codes are symptom codes, S codes are fractures, O codes are obstetrics, M codes are musculoskeletal and so on, the correlation of the alpha to a body system is purely coincidental.
I hope this helps you (I teach ICD-10 CM)

T36.0x5A


----------



## Susan (Aug 22, 2013)

kwhite2008 said:


> Hello- I am part of the ICD-10 project team for our organization and after a presentation, one of the physicians on the team asked if certain alpha digits are always going to mean the same thing for example: R for replacement. As I tried to look into this further for him, I am seeing a pattern that after the period, the 4th and 5th characters are always numbers, sometimes the 6th is as well but if the code requires a 7th digit, you would use x for the placeholder and the 7th digits vary by chapter of if they are a number or a letter but tend to stay consistent. Is the pattern that I think I am seeing correct?
> Thanks!
> 
> Kim, CPC



Kim;

Are you looking at both PCS and CM.  Your physician's example of the R=replacement sounds more of PCS then CM.  The chapter in CM that begins with R is Signs and Symptoms.  I have not seen any CM codes that begin with 2 letters, but there are codes with a mix of letter and numbers such as Z3A.12 to indicate 12 weeks of gestation.  I hope this helps.


----------



## sivdon (Aug 29, 2013)

*siva*

Very helpful explanation


----------

