Guidelines › Placeholder X and the 7th character

Placeholder X and the 7th character

Official text from the FY2027 ICD-10-CM Official Guidelines for Coding and Reporting. The wording is quoted exactly.

Guidelines I.A.4; I.A.5

“Where a placeholder exists, the X must be used in order for the code to be considered a valid code.”

“If a code that requires a 7th character is not 6 characters, a placeholder X must be used to fill in the empty characters.”

“A code that has an applicable 7th character is considered invalid without the 7th character.”

Where this applies

This is a general rule. It applies to code assignment everywhere, not to one code or group of codes.

Source: FY 2027 ICD-10-CM Official Guidelines for Coding and Reporting, effective October 1, 2026. Full Guidelines (PDF, CMS)