S80.261A (Insect bite (nonvenomous), right knee, initial encounter) compared with S80.261D (Insect bite (nonvenomous), right knee, subsequent encounter), from the official CMS tabular data. S80.261A and S80.261D 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. S80.261A and S80.261D 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.
| S80.261AInsect bite (nonvenomous), right knee, initial encounter | S80.261DInsect bite (nonvenomous), right knee, 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 | Insect bite (nonvenomous), right knee, initial encounter is a billable ICD-10-CM diagnosis code (S80.261A). | Insect bite (nonvenomous), right knee, subsequent encounter is a billable ICD-10-CM diagnosis code (S80.261D). |
| 7th character | The appropriate 7th character is to be added to each code from category S80 | The appropriate 7th character is to be added to each code from category S80 |
Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources