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When to use Dummy Placeholder “X” with ICD 10 codes

ICD 9 we have straight numerical or alphanumeric codes. In ICD 9, we use to have minimum 3 or maximum 5 characters or digits for coding a diagnosis code. However, ICD 10 codes are little different with respect to ICD 9 codes. ICD 10 have minimum 3 and maximum 7 character or digits for coding diagnosis codes. Moreover, ICD 10 codes are fully alphanumeric codes. There are few new terms included in ICD 10 like Excludes 1 and Excludes 2 and a dummy placeholder ‘X’. Now, about Excludes 1 and 2, I have already shared my views and now we will try to learn more about Placeholder ‘X’.

When to use Dummy Placeholder “X” with ICD 10 codes

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When to use Placeholder X

Coding correct diagnosis code is very important in outpatient and inpatient coding. We know we have new ICD 10 PCS procedure codes hence we should be perfect with coding ICD 10 diagnosis codes. Use of placeholder X is not as tricky as the root operations of ICD 10 PCS and hence one should not have any difficulty while using them. Placeholder ‘X’ is only used to for expansion of ICD 10 code.  It is simple to understand the placeholder X is used to fill empty spaces in ICD 10 to complete the code. For example, in poisoning, adverse effect, underdosing (T36-T50) chapter, the sixth character 1 represent for accidental and 2 represent for intentional self-harm. However, for these ICD 10 codes the fifth character place is empty and hence is filled with dummy placeholder X.

T37.5X1 – Poising by antiviral drugs, accidental (unintentional)
T37.5X2 – Poising by antiviral drugs, intentional self-harm.

The main point to remember here is not use the six character 1 and 2 at the wrong place. The six character should be placed in six digit and the empty space in between should be fulfilled with placeholder X.

Read also: Common mistakes done with ICD 10 codes

Point to remember while using Placeholder X

Placeholder should be used only after decimal point, and you can use minimum 1 or maximum 3 (for example, X58.XXXA) placeholder in ICD 10 codes.Assign only three character diagnosis code, when it is not further divided into fourth, fifth, sixth or seventh code. Do not use Placeholder X just to expand the code like J20.9XXX which is totally wrong.

Assign a fourth, fifth, sixth and seventh character code till it is further divided into different subcategories.

Use sixth character and seventh character (A,D and S encounter in injury codes) only in their respective places. Use placeholder X to fill the gap if no characters available in between.

Assign the most specific ICD 10 codes and use placeholder appropriate to correctly define the ICD 10 code.