Dr santosh guptha on Instagram: "How to Assign A D S in ICD 10 CM Coding - MEDESUN Medical Coding Academy . Learn the correct 7th character rules with Medesun Medical Coding Academy A – Initial Encounter Use A when the patient is receiving active treatment Examples Emergency care Surgery Initial evaluation Active management of fracture or injury D – Subsequent Encounter Use D for follow up visits Examples Routine healing visits Cast change Medication adjustment Regular follow up after active tre