ICD-10-CM 7th Character Values ICD-10-CM
Some ICD-10-CM categories require a 7th character that records the encounter, the healing status, the fetus, the eye or the stage. In FY 2027, 508 categories and subcategories declare one, covering 51,378 complete codes. They use only 15 distinct sets of values, listed below with every category that uses each set.
Certain ICD-10-CM categories have applicable 7th characters. The applicable 7th character is required for all codes within the category, or as the notes in the Tabular List instruct. The 7th character must always be the 7th character in the data field. If a code that requires a 7th character is not 6 characters, a placeholder X must be used to fill in the empty characters (Section I.A.4).
All 15 7th Character Value Sets 508 rules
| Value Set | Values | Categories | Codes |
|---|---|---|---|
| Encounter: Initial, Subsequent, Sequela The most common 7th character set: A for the initial encounter (active treatment), D for subsequent encounters (healing or recovery phase) and S for sequela (late effects). Used across injuries, poisonings and other external-cause categories. | A initial encounterD subsequent encounterS sequela | 409 | 31,412 |
| Eye Laterality Identifies the affected eye for diabetic retinopathy and related eye conditions: 1 right eye, 2 left eye, 3 bilateral, 9 unspecified eye. | 1 right eye2 left eye3 bilateral9 unspecified eye | 25 | 260 |
| Closed Fracture Encounter Encounter and healing status for fractures coded as closed: initial encounter, subsequent encounter with routine healing, delayed healing, nonunion or malunion, and sequela. | A initial encounter for closed fractureD subsequent encounter for fracture with routine healingG subsequent encounter for fracture with delayed healingK subsequent encounter for fracture with nonunionP subsequent encounter for fracture with malunionS sequela | 18 | 1,314 |
| Fetus Identification Identifies which fetus is affected in a multiple gestation: 0 not applicable or unspecified, 1 through 5 for fetus 1 to 5, and 9 for other fetus. | 0 not applicable or unspecified1 fetus 12 fetus 23 fetus 34 fetus 45 fetus 59 other fetus | 15 | 1,260 |
| Glaucoma Stage Records the stage of glaucoma: unspecified, mild, moderate, severe or indeterminate. | 0 stage unspecified1 mild stage2 moderate stage3 severe stage4 indeterminate stage | 11 | 190 |
| Pathological Fracture Encounter Encounter and healing status for pathological, osteoporotic, stress and atypical femoral fractures. | A initial encounter for fractureD subsequent encounter for fracture with routine healingG subsequent encounter for fracture with delayed healingK subsequent encounter for fracture with nonunionP subsequent encounter for fracture with malunionS sequela | 6 | 1,224 |
| Open or Closed Fracture Encounter Fracture encounter status that also distinguishes an initial encounter for a closed fracture (A) from an open fracture (B). | A initial encounter for closed fractureB initial encounter for open fractureD subsequent encounter for fracture with routine healingG subsequent encounter for fracture with delayed healingK subsequent encounter for fracture with nonunionP subsequent encounter for fracture with malunionS sequela | 6 | 5,019 |
| Coma Scale Timing Records when the Glasgow coma scale score was assessed: in the field, at arrival to the emergency department, at hospital admission, or 24 hours or more after admission. | 0 unspecified time1 in the field [EMT or ambulance]2 at arrival to emergency department3 at hospital admission4 24 hours or more after hospital admission | 4 | 95 |
| Skull, Spine and Pelvis Fracture Encounter Fracture encounter status for skull, facial, vertebral, rib and pelvic fractures. This set has no malunion (P) value. | A initial encounter for closed fractureB initial encounter for open fractureD subsequent encounter for fracture with routine healingG subsequent encounter for fracture with delayed healingK subsequent encounter for fracture with nonunionS sequela | 4 | 2,070 |
| Open Fracture Type Encounter The most detailed fracture set, used for forearm, femur and lower leg fractures. It separates closed fractures, open fractures type I or II, and open fractures type IIIA, IIIB or IIIC for every encounter and healing status. | A initial encounter for closed fractureB initial encounter for open fracture type I or IIC initial encounter for open fracture type IIIA, IIIB, or IIICD subsequent encounter for closed fracture with routine healingE subsequent encounter for open fracture type I or II with routine healingF subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healingG subsequent encounter for closed fracture with delayed healingH subsequent encounter for open fracture type I or II with delayed healingJ subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healingK subsequent encounter for closed fracture with nonunionM subsequent encounter for open fracture type I or II with nonunionN subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunionP subsequent encounter for closed fracture with malunionQ subsequent encounter for open fracture type I or II with malunionR subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunionS sequela | 3 | 8,160 |
| Retinal Vein Occlusion Status Records the status of a retinal vein occlusion: with macular edema, with retinal neovascularization, or stable. | 0 with macular edema1 with retinal neovascularization2 stable | 2 | 24 |
| Vertebral Fracture Encounter Encounter and healing status for fatigue fractures and collapsed vertebrae. | A initial encounter for fractureD subsequent encounter for fracture with routine healingG subsequent encounter for fracture with delayed healingS sequela of fracture | 2 | 72 |
| Dry Macular Degeneration Stage Records the stage of nonexudative (dry) age-related macular degeneration. | 0 stage unspecified1 early dry stage2 intermediate dry stage3 advanced atrophic without subfoveal involvement4 advanced atrophic with subfoveal involvement | 1 | 20 |
| Wet Macular Degeneration Stage Records the stage of exudative (wet) age-related macular degeneration. | 0 stage unspecified1 with active choroidal neovascularization2 with inactive choroidal neovascularization3 with inactive scar | 1 | 16 |
| Chronic Gout Tophus Records whether chronic gout is with or without tophus (tophi). | 0 without tophus (tophi)1 with tophus (tophi) | 1 | 242 |
How to Build a Code With a 7th Character
The 7th character is always the seventh position of the code. When the code it is added to has fewer than six characters, the placeholder X fills the empty positions (Section I.A.4). For example, T36.0X1A, poisoning by penicillins, accidental, initial encounter, uses an X in the fifth position so that A lands in the seventh; a code missing its placeholder or its 7th character is invalid.
In chapter 19, injuries, most categories use A for the initial encounter, D for a subsequent encounter and S for sequela. The choice depends on treatment, not on the provider: A is used for each encounter where the patient is receiving active treatment for the condition, D once active treatment is complete and the patient receives routine care during the healing or recovery phase, and S for complications or conditions that arise as a direct result of the injury (Section I.C.19.a).
Questions About 7th Characters
What is the 7th character in ICD-10-CM?
A required final character that some categories use to add information the rest of the code does not carry, such as the encounter type for injuries, the fracture healing status, the fetus in a multiple gestation, the eye, or the stage of a disease. The applicable 7th character is required for all codes within the category, or as the Tabular List notes instruct (Section I.A.5).
Why does a code need an X before the 7th character?
The 7th character must always be in the seventh position. If the code it is added to is shorter than six characters, the placeholder X fills the gap, as in T36.0X1A. Without it the code is invalid (Sections I.A.4 and I.A.5).
What is the difference between A, D and S?
A (initial encounter) is used while the patient receives active treatment; D (subsequent encounter) after active treatment, for routine care during healing or recovery; S (sequela) for a late effect of the injury, with the sequela itself coded first (Section I.C.19.a).
How many ICD-10-CM codes have a 7th character?
51,378 codes in FY 2027, from 508 categories and subcategories with a 7th character rule. The encounter set (A, D, S) alone covers 31,412 of them.
Official Sources & Methodology
Every note on these pages is loaded verbatim from the FY 2027 ICD-10-CM Tabular List. Code references inside the notes are matched against the FY 2027 code set, so every link opens a valid code; scope counts (“applies to N codes”) count the billable codes under the note’s chapter, block or category.
- CMS ICD-10-CM FilesThe Tabular List (XML) that every note, note type and code reference on ICD List comes from.
- ICD-10-CM Official Guidelines for Coding and Reporting FY 2027Section I.A, Conventions for the ICD-10-CM, defines each note type; the definitions on these pages follow its wording.
ICD List is not affiliated with CMS or NCHS. These pages are a coding reference; the Tabular List and the Official Guidelines remain the authority.
Related References
Source: FY 2027 ICD-10-CM Tabular List (CMS and NCHS) and the ICD-10-CM Official Guidelines for Coding and Reporting FY 2027, Section I.A. ICD List is not affiliated with CMS or NCHS.
