Tracy Blevins, MSHIM, RHIA • July 22, 2025

Initial vs. Subsequent Encounters in ICD-10-CM: Getting the 7th Character Right

Why the 7th Character Matters in Injury Coding

Many coders still struggle with assigning the seventh character for initial and subsequent encounters. Using these correctly ensures accurate reimbursement and avoids claim denials. 


Initial Encounter (7th Character “A”): Active Treatment

When assigning the 7th character for injuries or conditions like fractures, sprains, or open wounds, do not confuse “initial” with the patient’s first visit. 


  • Initial Encounter (A) = Active treatment is still being provided – “surgical treatment, emergency department encounter, and evaluation and continuing treatment by the same or a different physician.” 


 

Subsequent Encounter (7th Character “D”): Routine Aftercare


  • Subsequent Encounter (D) = The patient is in the healing or recovery phase, receiving routine follow-up care - “cast change or removal, an X-ray to check healing status of fracture, removal of an external or internal fixation device, medication adjustment, and other aftercare and follow-up visits following treatment of the injury or condition.” 

 

Key Coding Rule: Care Phase Matters More Than Care Setting

In ICD-10-CM, “initial” vs. “subsequent” is about the type of care being provided, not the location (like inpatient vs. outpatient) 

 

  • Use 7th character “A” (Initial Encounter) when the patient is receiving active treatment for the injury – regardless of whether they’re in the ER, surgery, or admitted inpatient. 
  • Use 7th character “D” (Subsequent Encounter) once the patient is receiving routine aftercare for healing – even if they are still in the hospital (e.g., rehab or post-op management).

 

Chart showing examples of initial and subsequent encounters for ICD-10-CM injury coding.
Tracy Blevins, MSHIM, RHIA, Senior Consultant, Audit at UASI

Tracy Blevins, MSHIM, RHIA 

Senior Consultant, Audit at UASI


Tracy Blevins is a Senior Consultant in Quality Auditing at UASI, with 14+ years of inpatient medical coding and health information management experience. As a Registered Health Information Administrator that also holds AHIMA’s Auditing Inpatient Coding Microcredential, she shares practical, detail-driven coding tips to help clinicians and coders strengthen documentation, accuracy, and compliance. 


Works Cited:

American Hospital Association. (2015). Initial and subsequent encounters for injuries. Coding Clinic for ICD-10-CM and ICD-10-PCS, First Quarter 2015, pp. 3–21.


Centers for Medicare & Medicaid Services. (2022). ICD-10-CM Official Guidelines for Coding and Reporting. U.S. Department of Health and Human Services. Available at: https://www.cms.gov


American Academy of Professional Coders. (n.d.). Resolve initial vs. subsequent encounter misconceptions. AAPC Knowledge Center. Available at: https://www.aapc.com/blog/82768-resolve-initial-vs-subsequent-encounter-misconceptions/


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