Place Holder X

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.

Not every ICD-10-CM code with a seventh character has a sixth character—or even a fifth or fourth character for that matter.

This frequently occurs with poisonings and injuries. 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. Without this placeholder to ensure characters appear in the correct positions, codes are invalid.

For example, a patient presents with an accidental poisoning by an antiallergic drug. For the initial encounter, coders should report ICD-10-CM code T45.0x1A. In this case, the x in the fifth position serves as a placeholder so that the sixth and seventh characters are in the correct position. If a coder inadvertently omits the placeholder, the resulting code would be T45.01A, which is invalid.

Coders should also note that an ICD-10-CM code can start with an X (i.e., codes X00-X99). For example, in code category X78.0, the X denotes the intention of an injury, exposure, etc. The X series of codes is part of Chapter 20: External Causes of Morbidity.

Note that the location of the X within a code matters. When x is in the fourth, fifth, and/or sixth character, it appears lowercase and is a placeholder. When X is at the beginning of the code, it is uppercase and indicates the chapter.

Complete ICD-10 codes can range in length from three characters to seven. Generally speaking, every character to the right of the decimal point adds its own element of meaning, and that meaning can vary from code to code. As you can see from the five- and seven-character examples below, each character to the right of the decimal place can indicate something about complications, cause, body part involved, etc. Consequently, code selection depends heavily on familiarity with the instructions given at the chapter, category, and code levels. Compare the longest versions of these codes and codes discussed elsewhere in the article to get a sense of the pattern variation you can expect in ICD-10 codes: Although they look quite different from one another, I10, E11.42, M1A.0721, and even W04.XXXA are all complete, valid codes.

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