Primary Care Coding Alert

Question: I am confused about the use of seventh characters when our provider removes sutures placed by another facility. As this is the first time we are seeing the patient, do I code this as an initial encounter? Or should this be coded as a subsequent encounter as the patient has already sought treatment for the problem? And when would it be appropriate to report a sequela encounter?

Pennsylvania Subscriber

Answer: The confusion over the way to apply seventh characters A (Initial encounter), D (Subsequent encounter), or S (Sequela) to a code from the Injury, Poisoning, and Certain Other Consequences of External Causes (S00-T88) chapter of ICD-10 stems from the belief that the characters apply to the encounter itself. So, it would be tempting to code suture removal for a patient with a laceration to the right thigh without a foreign body as S71.111A (Laceration without foreign body, right thigh, initial encounter) when your provider is seeing the patient for the first time to remove sutures placed from, say, a local emergency department (ED).

However, this would not be correct. ICD-10 guideline C.19.a states, “While the patient may be seen by a new or different provider over the course of treatment for an injury, assignment of the 7th character is based on whether the patient is undergoing active treatment and not whether the provider is seeing the patient for the first time.” So, you can think of the initial encounter seventh character A as an abbreviation for Active.

The fact that the patient is reporting to your provider to have sutures removed, however, indicates that the patient is no longer undergoing active treatment and that the injury has healed. This encounter would meet the ICD-10 criteria for a subsequent encounter, which is defined as an encounter “after the patient has completed active treatment of the condition and is receiving routine care for the condition during the healing or recovery phase.” In the case of lacerations, this would include suture removal, so you would code the encounter as S71.111D (Laceration without foreign body, right thigh, subsequent encounter).

As for the seventh character S, guideline C.19.a notes that this character is “for use for complications or conditions that arise as a direct result of the condition, such as a scar formation after a burn.” So, if your patient returned sometime after the encounter to be treated for pain from the scar contracting and thickening, you would code the injury with S71.111S (Laceration without foreign body, right thigh, sequela), sequencing a code such as L90.5 (Scar conditions and fibrosis of the skin) first for the encounter.