ICD-10 “X” Placeholder


October 16, 2014


I recently listened to a webinar on ICD-10. They discussed the x placeholder, but I still don’t understand exactly when to use it. Can you help explain?


Absolutely we can help! The “X” placeholder has two functions in ICD-10-CM. First, it is used with some codes as a placeholder for future code expansion. It holds the data field to be able to place a new alphanumeric character if the definition of the code is expanded in updates to the code set. ICD-10-CM code H66.3X1 (Other chronic suppurative otitis media, right ear) is an example of how the “X” character is used as a placeholder for future code expansion. The “X” has to remain in the code or it becomes invalid.

The second use of the “X” placeholder is to fill data fields to be able to append 7th characters when the code is less than 6 characters in length. 7th character extensions are added to certain codes to further define the condition.

There are three main 7th character extensions: A-initial encounter, D-subsequent encounter, S-sequela. Fractures are the exception and have different 7th characters. The 7th character extensions are noted at the beginning of each code category. The codes otolaryngologists will use that require 7th characters are for injuries (e.g., foreign bodies, fractures, open wounds).

Because not all codes are 6 characters in length, an “X” is put in the empty data fields so the 7th character extension can be placed in the 7th character data field. For example, S02.2 is the code for fracture of nasal bones, but per the instructions at the beginning of the code category, this code will require a 7th character extension to be added to the code to make the code valid. Because this code is only 4 characters in length, “X”s are placed in the 5th and 6th data fields to add the 7th character. Therefore, the valid code for a diagnosis of open fracture of nasal bones, initial encounter is S02.2XXB.

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