2024 ICD-10-CM Diagnosis Code T37.5X6D

Underdosing of antiviral drugs, subsequent encounter

ICD-10-CM Code:
T37.5X6D
ICD-10 Code for:
Underdosing of antiviral drugs, subsequent encounter
Is Billable?
Yes - Valid for Submission
Chronic Condition Indicator: [1]
Not chronic
Code Navigator:

Code Classification

  • Injury, poisoning and certain other consequences of external causes
    (S00–T88)
    • Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances
      (T36-T50)
      • Poisoning by, adverse effect of and underdosing of other systemic anti-infectives and antiparasitics
        (T37)

T37.5X6D is a billable diagnosis code used to specify a medical diagnosis of underdosing of antiviral drugs, 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.

T37.5X6D 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 antiviral drugs. 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 Information

  • Acyclovir

    a guanosine analog that acts as an antimetabolite. viruses are especially susceptible. used especially against herpes.
  • Valacyclovir

    a prodrug of acyclovir that is used in the treatment of herpes zoster and herpes simplex virus infection of the skin and mucous membranes, including genital herpes.
  • Inosine Pranobex

    an alkylamino-alcohol complex of inosine used in the treatment of a variety of viral infections. unlike other antiviral agents, it acts by modifying or stimulating cell-mediated immune processes rather than acting on the virus directly.
  • Methisazone

    an antiviral agent effective against pox viruses.
  • Ribavirin

    a nucleoside antimetabolite antiviral agent that blocks nucleic acid synthesis and is used against both rna and dna viruses.
  • Rimantadine

    an rna synthesis inhibitor that is used as an antiviral agent in the prophylaxis and treatment of influenza.
  • Thymopentin

    synthetic pentapeptide corresponding to the amino acids 32-36 of thymopoietin and exhibiting the full biological activity of the natural hormone. it is an immunomodulator which has been studied for possible use in the treatment of rheumatoid arthritis, aids, and other primary immunodeficiencies.
  • Trifluridine

    an antiviral derivative of thymidine used mainly in the treatment of primary keratoconjunctivitis and recurrent epithelial keratitis due to herpes simplex virus. (from martindale, the extra pharmacopoeia, 30th ed, p557)
  • Vidarabine

    a nucleoside antibiotic isolated from streptomyces antibioticus. it has some antineoplastic properties and has broad spectrum activity against dna viruses in cell cultures and significant antiviral activity against infections caused by a variety of viruses such as the herpes viruses, the vaccinia virus and varicella zoster virus.
  • Vidarabine Phosphate

    an adenosine monophosphate analog in which ribose is replaced by an arabinose moiety. it is the monophosphate ester of vidarabine with antiviral and possibly antineoplastic properties.
  • Zalcitabine

    a dideoxynucleoside compound in which the 3'-hydroxy group on the sugar moiety has been replaced by a hydrogen. this modification prevents the formation of phosphodiester linkages which are needed for the completion of nucleic acid chains. the compound is a potent inhibitor of hiv replication at low concentrations, acting as a chain-terminator of viral dna by binding to reverse transcriptase. its principal toxic side effect is axonal degeneration resulting in peripheral neuropathy.
  • Zidovudine

    a dideoxynucleoside compound in which the 3'-hydroxy group on the sugar moiety has been replaced by an azido group. this modification prevents the formation of phosphodiester linkages which are needed for the completion of nucleic acid chains. the compound is a potent inhibitor of hiv replication, acting as a chain-terminator of viral dna during reverse transcription. it improves immunologic function, partially reverses the hiv-induced neurological dysfunction, and improves certain other clinical abnormalities associated with aids. its principal toxic effect is dose-dependent suppression of bone marrow, resulting in anemia and leukopenia.

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 other systemic anti-infectives and antiparasitics (T37). 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)

T37.5X6D 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 IndicatorReason for CodeCMS will pay the CC/MCC DRG?
YDiagnosis was present at time of inpatient admission.YES
NDiagnosis was not present at time of inpatient admission.NO
UDocumentation insufficient to determine if the condition was present at the time of inpatient admission.NO
WClinically undetermined - unable to clinically determine whether the condition was present at the time of inpatient admission.YES
1Unreported/Not used - Exempt from POA reporting. NO

Convert T37.5X6D to ICD-9-CM

  • ICD-9-CM Code: -
    No Map Flag -

Table of Drugs and Chemicals

The parent code T37.5X6 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.

Substance Poisoning
Accidental
(unintentional)
Poisoning
Accidental
(self-harm)
Poisoning
Assault
Poisoning
Undetermined
Adverse
effect
Underdosing
ABOBT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
AciclovirT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
AcyclovirT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
Antiviral drug NECT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
Antiviral drug NEC
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T37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
Ara-AT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
AzidothymidineT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
AZTT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
DideoxycytidineT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
DideoxyinosineT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
FlumidinT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
Foscarnet sodiumT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
Fosfonet sodiumT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
Ganciclovir (sodium)T37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
IbacitabineT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
Inosine pranobexT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
Interferon (alpha) (beta) (gamma)T37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
MethisazoneT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
MethisoprinolT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
MetisazoneT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
MoroxydineT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
RibavirinT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
RimantadineT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
ThymopentinT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
TrifluridineT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
TromantadineT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
VidarabineT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
VirugonT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
ZalcitabineT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6
ZidovudineT37.5X1T37.5X2T37.5X3T37.5X4T37.5X5T37.5X6

Patient Education


Medication Errors

Medicines treat infectious diseases, prevent problems from chronic diseases, and ease pain. But medicines can also cause harmful reactions if not used correctly. Errors can happen in the hospital, at the health care provider's office, at the pharmacy, or at home. You can help prevent errors by:

  • Knowing your medicines. When you get a prescription, ask the name of the medicine and check to make sure that the pharmacy gave you the right medicine. Make sure that you understand how often you should take the medicine and how long you should take it.
  • Keeping a list of medicines.
    • Write down all of the medicines that you are taking, including the names of your medicines, how much you take, and when you take them. Make sure to include any over-the-counter medicines, vitamins, supplements, and herbs that you take.
    • List the medicines that you are allergic to or that have caused you problems in the past.
    • Take this list with you every time you see a health care provider.
  • Reading medicine labels and following the directions. Don't just rely on your memory - read the medication label every time. Be especially careful when giving medicines to children.
  • Asking questions. If you don't know the answers to these questions, ask your health care provider or pharmacist:
    • Why am I taking this medicine?
    • What are the common side effects?
    • What should I do if I have side effects?
    • When should I stop this medicine?
    • Can I take this medicine with the other medicines and supplements on my list?
    • Do I need to avoid certain foods or alcohol while taking this medicine?

Food and Drug Administration


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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.