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Placeholders - ICD-10-CM

Vijayarani Sivakumar

Published On - May 06, 2020

The letter "x” serves as a placeholder when a code contains fewer than six characters and a seventh character applies. The "x” also allows for future expansion of the codes. When reporting ICD-10-CM codes, coders must add a placeholder so the seventh character is in the correct position.

ICD-10-CM has another important convention that has to do with the code’s extensions. Remember, extensions typically provide information what encounter this is for the healthcare provider with the patient. These are not always included, but in the case that they are, they cannot simply be appended to the end of whatever code is attached. Extensions are only found in the seventh character of an ICD-10-CM code.

If a coder has to include an extension for an initial encounter on a code that does not have six characters, they must add placeholder characters. Coders use an ‘X’ for the placeholder digit.

If, for example, a coder needs to code an instance of poisoning by unintentional underdosing of antibiotic penicillin, the coder would use T36.0X1A. In this case, the fifth digit is empty, and so we’d use the placeholder character ‘X.’ Remember that placeholder characters are only used when an extension is necessary. Most ICD-10 codes do not include an extension for the encounter.

The number of characters signifying an ICD-10 diagnosis varies. For example, when coding for ophthalmic complications from diabetes, there will be seven characters. But not all of them mean something.

E11.3211 - Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with macular edema, right eye

<!--[if !supportLists]-->·         <!--[endif]-->The first three characters, describe the type of diabetes.

<!--[if !supportLists]-->·         <!--[endif]-->The fourth character communicates the diabetes has complications for an eye (or both).

<!--[if !supportLists]-->·         <!--[endif]-->The fifth and sixth characters show the specific complication.

<!--[if !supportLists]-->·         <!--[endif]-->The seventh character designates laterality.

Sometimes only one character is needed to designate a complication but there will always be a seventh character designating laterality. So when there is a fifth character but not a sixth, use X as a placeholder as a sixth character.