2024 ICD-10-CM Diagnosis Code T36.1X6D
Underdosing of cephalosporins and other beta-lactam antibiotics, subsequent encounter
- ICD-10-CM Code:
- T36.1X6D
- ICD-10 Code for:
- Underdosing of cephalospor/oth beta-lactm antibiotics, subs
- Is Billable?
- Yes - Valid for Submission
- Chronic Condition Indicator: [1]
- Not chronic
- Code Navigator:
T36.1X6D is a billable diagnosis code used to specify a medical diagnosis of underdosing of cephalosporins and other beta-lactam antibiotics, subsequent encounter. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024. The code is exempt from present on admission (POA) reporting for inpatient admissions to general acute care hospitals.
This code describes a circumstance which influences the patient's health status but not a current illness or injury. The code is unacceptable as a principal diagnosis.
T36.1X6D is a subsequent encounter code, includes a 7th character and should be used after the patient has completed active treatment for a condition like underdosing of cephalosporins and other beta-lactam antibiotics. According to ICD-10-CM Guidelines a "subsequent encounter" occurs when the patient is receiving routine care for the condition during the healing or recovery phase of treatment. Subsequent diagnosis codes are appropriate during the recovery phase, no matter how many times the patient has seen the provider for this condition. If the provider needs to adjust the patient's care plan due to a setback or other complication, the encounter becomes active again.
Clinical Classification
Clinical Category is Underdosing of drugs and medicaments, subsequent encounter
- CCSR Category Code: INJ066
- Inpatient Default CCSR: X - Not applicable.
- Outpatient Default CCSR: X - Not applicable.
Clinical Information
Aztreonam
a monocyclic beta-lactam antibiotic originally isolated from chromobacterium violaceum. it is resistant to beta-lactamases and is used in gram-negative infections, especially of the meninges, bladder, and kidneys. it may cause a superinfection with gram-positive organisms.Cefaclor
semisynthetic, broad-spectrum antibiotic derivative of cephalexin.Cefadroxil
long-acting, broad-spectrum, water-soluble, cephalexin derivative.Cefamandole
semisynthetic wide-spectrum cephalosporin with prolonged action, probably due to beta-lactamase resistance. it is used also as the nafate.Cefatrizine
orally active semisynthetic cephalosporin antibiotic with broad-spectrum activity.Cefazolin
a semisynthetic cephalosporin analog with broad-spectrum antibiotic action due to inhibition of bacterial cell wall synthesis. it attains high serum levels and is excreted quickly via the urine.Cefixime
a third-generation cephalosporin antibiotic that is stable to hydrolysis by beta-lactamases.Cefmenoxime
a cephalosporin antibiotic that is administered intravenously or intramuscularly. it is active against most common gram-positive and gram-negative microorganisms, is a potent inhibitor of enterobacteriaceae, and is highly resistant to hydrolysis by beta-lactamases. the drug has a high rate of efficacy in many types of infection and to date no severe side effects have been noted.Cefmetazole
a semisynthetic cephamycin antibiotic with a broad spectrum of activity against both gram-positive and gram-negative microorganisms. it has a high rate of efficacy in many types of infection and to date no severe side effects have been noted.Cefonicid
a second-generation cephalosporin administered intravenously or intramuscularly. its bactericidal action results from inhibition of cell wall synthesis. it is used for urinary tract infections, lower respiratory tract infections, and soft tissue and bone infections.Cefoperazone
semisynthetic broad-spectrum cephalosporin with a tetrazolyl moiety that is resistant to beta-lactamase. it may be used to treat pseudomonas infections.Cefotaxime
semisynthetic broad-spectrum cephalosporin.Cefotetan
a semisynthetic cephamycin antibiotic that is administered intravenously or intramuscularly. the drug is highly resistant to a broad spectrum of beta-lactamases and is active against a wide range of both aerobic and anaerobic gram-positive and gram-negative microorganisms.Cefotiam
one of the cephalosporins that has a broad spectrum of activity against both gram-positive and gram-negative microorganisms.Cefoxitin
a semisynthetic cephamycin antibiotic resistant to beta-lactamase.Cefsulodin
a pyridinium-substituted semisynthetic, broad-spectrum antibacterial used especially for pseudomonas infections in debilitated patients.Ceftazidime
semisynthetic, broad-spectrum antibacterial derived from cephaloridine and used especially for pseudomonas and other gram-negative infections in debilitated patients.Ceftizoxime
a semisynthetic cephalosporin antibiotic which can be administered intravenously or by suppository. the drug is highly resistant to a broad spectrum of beta-lactamases and is active against a wide range of both aerobic and anaerobic gram-positive and gram-negative organisms. it has few side effects and is reported to be safe and effective in aged patients and in patients with hematologic disorders.Ceftriaxone
a broad-spectrum cephalosporin antibiotic and cefotaxime derivative with a very long half-life and high penetrability to meninges, eyes and inner ears.Cefuroxime
broad-spectrum cephalosporin antibiotic resistant to beta-lactamase. it has been proposed for infections with gram-negative and gram-positive organisms, gonorrhea, and haemophilus.Cephalexin
a semisynthetic cephalosporin antibiotic with antimicrobial activity similar to that of cephaloridine or cephalothin, but somewhat less potent. it is effective against both gram-positive and gram-negative organisms.Cephalosporinase
Cephaloglycin
a cephalorsporin antibiotic.Cephaloridine
a cephalosporin antibiotic.Cephalosporins
a group of broad-spectrum antibiotics first isolated from the mediterranean fungus acremonium. they contain the beta-lactam moiety thia-azabicyclo-octenecarboxylic acid also called 7-aminocephalosporanic acid.Cephalothin
a cephalosporin antibiotic.Cephradine
a semi-synthetic cephalosporin antibiotic.Clavulanic Acid
a beta-lactam antibiotic produced by the actinobacterium streptomyces clavuligerus. it is a suicide inhibitor of bacterial beta-lactamase enzymes. administered alone, it has only weak antibacterial activity against most organisms, but given in combination with other beta-lactam antibiotics it prevents antibiotic inactivation by microbial lactamase.Clavulanic Acids
acids, salts, and derivatives of clavulanic acid (c8h9o5n). they consist of those beta-lactam compounds that differ from penicillin in having the sulfur of the thiazolidine ring replaced by an oxygen. they have limited antibacterial action, but block bacterial beta-lactamase irreversibly, so that similar antibiotics are not broken down by the bacterial enzymes and therefore can exert their antibacterial effects.
Coding Guidelines
Underdosing refers to taking less of a medication than is prescribed by a provider or a manufacturer's instruction. Codes for underdosing should never be assigned as principal or first-listed codes. If a patient has a relapse or exacerbation of the medical condition for which the drug is prescribed because of the reduction in dose, then the medical condition itself should be coded.
The appropriate 7th character is to be added to each code from block Poisoning by, adverse effect of and underdosing of systemic antibiotics (T36). Use the following options for the aplicable episode of care:
- A - initial encounter
- D - subsequent encounter
- S - sequela
Code Edits
The Medicare Code Editor (MCE) detects and reports errors in the coding of claims data. The following ICD-10-CM Code Edits are applicable to this code:
- Unacceptable principal diagnosis - There are selected codes that describe a circumstance which influences an individual's health status but not a current illness or injury, or codes that are not specific manifestations but may be due to an underlying cause. These codes are considered unacceptable as a principal diagnosis.
Present on Admission (POA)
T36.1X6D is exempt from POA reporting - The Present on Admission (POA) indicator is used for diagnosis codes included in claims involving inpatient admissions to general acute care hospitals. POA indicators must be reported to CMS on each claim to facilitate the grouping of diagnoses codes into the proper Diagnostic Related Groups (DRG). CMS publishes a listing of specific diagnosis codes that are exempt from the POA reporting requirement. Review other POA exempt codes here.
CMS POA Indicator Options and Definitions
POA Indicator | Reason for Code | CMS will pay the CC/MCC DRG? |
---|---|---|
Y | Diagnosis was present at time of inpatient admission. | YES |
N | Diagnosis was not present at time of inpatient admission. | NO |
U | Documentation insufficient to determine if the condition was present at the time of inpatient admission. | NO |
W | Clinically undetermined - unable to clinically determine whether the condition was present at the time of inpatient admission. | YES |
1 | Unreported/Not used - Exempt from POA reporting. | NO |
Table of Drugs and Chemicals
The parent code T36.1X6 of the current diagnosis code is referenced in the Table of Drugs and Chemicals, this table contains a classification of drugs, industrial solvents, corrosive gases, noxious plants, pesticides, and other toxic agents.
According to ICD-10-CM coding guidelines it is advised to do not code directly from the Table of Drugs and Chemicals, instead always refer back to the Tabular List when doing the initial coding. Each substance in the table is assigned a code according to the poisoning classification and external causes of adverse effects. It is important to use as many codes as necessary to specify all reported drugs, medicinal or chemical substances. If the same diagnosis code describes the causative agent for more than one adverse reaction, poisoning, toxic effect or underdosing, utilize the code only once.
Patient Education
Antibiotics
What are antibiotics?
Antibiotics are medicines that fight bacterial infections in people and animals. They work by killing the bacteria or by making it hard for the bacteria to grow and multiply.
Antibiotics can be taken in different ways:
- Orally (by mouth). This could be pills, capsules, or liquids.
- Topically. This might be a cream, spray, or ointment that you put on your skin. It could also be eye ointment, eye drops, or ear drops.
- Through an injection or intravenously (IV). This is usually for more serious infections.
What do antibiotics treat?
Antibiotics only treat certain bacterial infections, such as strep throat, urinary tract infections, and E. coli.
You may not need to take antibiotics for some bacterial infections. For example, you might not need them for many sinus infections or some ear infections. Taking antibiotics when they're not needed won't help you, and they can have side effects. Your health care provider can decide the best treatment for you when you're sick. Don't ask your provider to prescribe an antibiotic for you.
Do antibiotics treat viral infections?
Antibiotics do not work on viral infections. For example, you shouldn't take antibiotics for:
- Colds and runny noses, even if the mucus is thick, yellow, or green
- Most sore throats (except strep throat)
- Flu
- Most cases of bronchitis
What are the side effects of antibiotics?
The side effects of antibiotics range from minor to very severe. Some of the common side effects include:
- Rash
- Nausea
- Diarrhea
- Yeast infections
More serious side effects can include:
- C. diff infections, which cause diarrhea that can lead to severe colon damage and sometimes even death
- Severe and life-threatening allergic reactions
- Antibiotic resistance infections
Call your health care provider if you develop any side effects while taking your antibiotic.
Why is it important to take antibiotics only when they're needed?
You should only take antibiotics when they are needed because they can cause side effects and can contribute to antibiotic resistance. Antibiotic resistance happens when the bacteria change and become able to resist the effects of an antibiotic. This means that the bacteria continue to grow.
How do I use antibiotics correctly?
When you take antibiotics, it is important that you take them responsibly:
- Always follow the directions carefully. Finish your medicine even if you feel better. If you stop taking them too soon, some bacteria may survive and re-infect you.
- Don't save your antibiotics for later.
- Don't share your antibiotic with others.
- Don't take antibiotics prescribed for someone else. This may delay the best treatment for you, make you even sicker, or cause side effects.
Centers for Disease Control and Prevention
[Learn More in MedlinePlus]
Code History
- FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
- FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
- FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
- FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
- FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
- FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
- FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
- FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
- FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. This was the first year ICD-10-CM was implemented into the HIPAA code set.
Footnotes
[1] Not chronic - A diagnosis code that does not fit the criteria for chronic condition (duration, ongoing medical treatment, and limitations) is considered not chronic. Some codes designated as not chronic are acute conditions. Other diagnosis codes that indicate a possible chronic condition, but for which the duration of the illness is not specified in the code description (i.e., we do not know the condition has lasted 12 months or longer) also are considered not chronic.