S91.042A (Puncture wound with foreign body, left ankle, initial encounter) compared with S91.042D (Puncture wound with foreign body, left ankle, subsequent encounter), from the official CMS tabular data. S91.042A and S91.042D 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. S91.042A and S91.042D 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.
| S91.042APuncture wound with foreign body, left ankle, initial encounter | S91.042DPuncture wound with foreign body, left ankle, 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 | Puncture wound with foreign body, left ankle, initial encounter is a billable ICD-10-CM diagnosis code (S91.042A). | Puncture wound with foreign body, left ankle, subsequent encounter is a billable ICD-10-CM diagnosis code (S91.042D). |
| 7th character | The appropriate 7th character is to be added to each code from category S91 | The appropriate 7th character is to be added to each code from category S91 |
Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources