Chiropractic Coding & Compliance Alert

Question: How do we approach the usage of the “X” placeholder character in ICD-10?

Michigan subscriber

Answer: Remember that not all ICD-10 codes will have an alphanumeric character for every place in the code, but may require a seventh character. In fact, there are codes that do not have a fourth, fifth, or perhaps even a sixth place, yet they do possess a seventh character. To address this we use a place holder character “X” to fill up the gap to the seventh character. Codes can even start with an X (i.e., X00-X009).

The location of the X is very important as well as lower case and uppercase. If the “X” place holder is used as fourth, fifth, or sixth character it needs to be lower case. If it is used at the beginning of a code, it must be uppercase indicating the chapter.

ICD-10 Guidelines regarding place holder characters state that the ICD-10-CM utilizes a placeholder character “X” at certain codes to allow for future expansion. An example of this is at the poisoning, adverse effect and underdosing codes, categories T36-T50.

Where a placeholder exists, the “X” must be used in the proper code position in order for the code to be considered a valid code.

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