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Chiropractic Coding & Compliance Alert

Reader Question:

Learn More About the Seventh Character

Question: What are the guidelines for using A, D, or S as a seventh character?

Utah Subscriber

Answer: The seventh character denotes the type of encounter with the provider following an injury. You use the characters A, D and S to represent initial, subsequent and encounter for a sequelae respectively.

Use character A when the patient is undergoing active treatment, such as surgery, an emergency department visit, or evaluation and treatment by the provider. For instance, a patient falls and sustains a fracture in his leg. His presenting to the ED, evaluation, treatment and surgery (if needed) all would entail usage of character A in the diagnosis codes. Do not get confused with the word “initial” as first encounter only; you will continue to use this till the patient is receiving active treatment in a single continuum.

Use character D when the patient visits the provider at a later healing or recovery stage. Examples of subsequent encounter would include follow up visits to the doctor for cast removal, taking an X-ray to monitor the healing status, removal of fixators, and review of medications.

Reserve using character S for instances where the patient visits the provider pertaining to complications or conditions that may arise as a direct consequence of the initial injury.

Remember to update yourself on your payer’s policies on the usage of these characters from time to time. Payers such as Medicare, Chirocare, Blue Cross Blue Shield, workers compensation, and PI payers may update their guidelines in months to come.


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