S04.011A (Injury of optic nerve, right eye, initial encounter) compared with S04.011D (Injury of optic nerve, right eye, subsequent encounter), from the official CMS tabular data. S04.011A and S04.011D code the same injury at a different phase of treatment.
Same underlying diagnosis, different encounter phase.
The 7th character records the phase of care for the encounter being coded, so a single encounter takes one of these characters, not several. Review whether both phases belong on the same episode of care.
Source: ICD-10-CM Official Guidelines, Section I.C.19.a
Same injury, other encounter phase. S04.011A and S04.011D code the same injury at a different phase of treatment, set by the 7th character.
The 7th character records the type of care given at the encounter being coded (ICD-10-CM Official Guidelines, Section I.C.19.a), so one encounter takes one of these, not both.
| S04.011AInjury of optic nerve, right eye, initial encounter | S04.011DInjury of optic nerve, right eye, subsequent encounter | |
|---|---|---|
| Billing status | Billable | Billable |
| Classification | S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) | S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) |
| Definition | Injury of optic nerve, right eye, initial encounter is a billable ICD-10-CM diagnosis code (S04.011A). | Injury of optic nerve, right eye, subsequent encounter is a billable ICD-10-CM diagnosis code (S04.011D). |
| 7th character | The appropriate 7th character is to be added to each code from category S04 | The appropriate 7th character is to be added to each code from category S04 |
| Includes | injuries of ear injuries of eye injuries of face [any part] injuries of gum | injuries of ear injuries of eye injuries of face [any part] injuries of gum |
| Use additional code | code to identify any visual field defect or blindness (H53.4-, H54.-) | code to identify any visual field defect or blindness (H53.4-, H54.-) |
| Code first | any associated intracranial injury (S06.-) | any associated intracranial injury (S06.-) |
Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources