2024 ICD-10-CM Diagnosis Code T38.3X6D

Underdosing of insulin and oral hypoglycemic [antidiabetic] drugs, subsequent encounter

ICD-10-CM Code:
T38.3X6D
ICD-10 Code for:
Underdosing of insulin and oral hypoglycemic drugs, subs
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 hormones and their synthetic substitutes and antagonists, not elsewhere classified
        (T38)

T38.3X6D is a billable diagnosis code used to specify a medical diagnosis of underdosing of insulin and oral hypoglycemic [antidiabetic] 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.

T38.3X6D 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 insulin and oral hypoglycemic [antidiabetic] 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

  • Acetohexamide

    a sulfonylurea hypoglycemic agent that is metabolized in the liver to 1-hydrohexamide.
  • Buformin

    an oral hypoglycemic agent that inhibits gluconeogenesis, increases glycolysis, and decreases glucose oxidation.
  • Carbutamide

    a sulfonylurea antidiabetic agent with similar actions and uses to chlorpropamide. (from martindale, the extra pharmacopoeia, 30th ed, p277)
  • Chlorpropamide

    a sulfonylurea hypoglycemic agent used in the treatment of non-insulin-dependent diabetes mellitus not responding to dietary modification. (from martindale, the extra pharmacopoeia, 30th ed, p277)
  • Gliclazide

    an oral sulfonylurea hypoglycemic agent which stimulates insulin secretion.
  • Glipizide

    an oral hypoglycemic agent which is rapidly absorbed and completely metabolized.
  • Glucagon

    a 29-amino acid pancreatic peptide derived from proglucagon which is also the precursor of intestinal glucagon-like peptides. glucagon is secreted by pancreatic alpha cells and plays an important role in regulation of blood glucose concentration, ketone metabolism, and several other biochemical and physiological processes. (from gilman et al., goodman and gilman's the pharmacological basis of therapeutics, 9th ed, p1511)
  • Glucagon-Like Peptide 1

    a peptide of 36 or 37 amino acids that is derived from proglucagon and mainly produced by the intestinal l cells. glp-1(1-37 or 1-36) is further n-terminally truncated resulting in glp-1(7-37) or glp-1-(7-36) which can be amidated. these glp-1 peptides are known to enhance glucose-dependent insulin release, suppress glucagon release and gastric emptying, lower blood glucose, and reduce food intake.
  • Glucagon-Like Peptide 2

    a 33-amino acid peptide derived from the c-terminal of proglucagon and mainly produced by the intestinal l cells. it stimulates intestinal mucosal growth and decreased apoptosis of enterocytes. glp-2 enhances gastrointestinal function and plays an important role in nutrient homeostasis.
  • Glucagon-Like Peptide Receptors

    g-protein coupled cell surface receptors that bind glucagon-like peptides and are expressed by cells in pancreatic, intestinal, and neural tissues. these receptors regulate cellular responses to blood glucose, insulin, and inflammation signals.
  • Glucagon-Like Peptide-1 Receptor

    a receptor for glucagon-like peptide 1 (glp-1) expressed primarily on the surface of beta and ductal exocrine cells of the pancreas, as well as cells of other tissues. glp-1 acts through glp-1r to potentiate signaling in pancreatic cells in response to glucose-stimulated insulin secretion (gsis).
  • Glucagon-Like Peptide-2 Receptor

    a receptor for glucagon-like peptide 2 (glp-2) that is expressed on the surface of intestinal cells as well as neural cells. glp-2 and other peptides act through glp-2r to regulate cellular responses to blood glucose, inflammation, and food intake.
  • Glucagon-Like Peptides

    peptides derived from proglucagon which is also the precursor of pancreatic glucagon. despite expression of proglucagon in multiple tissues, the major production site of glucagon-like peptides (glps) is the intestinal l cells. glps include glucagon-like peptide 1, glucagon-like peptide 2, and the various truncated forms.
  • Glucagonoma

    an almost always malignant glucagon-secreting tumor derived from the pancreatic alpha cells. it is characterized by a distinctive migratory erythema; weight loss; stomatitis; glossitis; diabetes mellitus; hypoaminoacidemia; and normochromic normocytic anemia.
  • Glucagon-Secreting Cells

    a type of pancreatic cell representing about 5-20% of the islet cells. alpha cells secrete glucagon.
  • Proglucagon

    the common precursor polypeptide of pancreatic glucagon and intestinal glucagon-like peptides. proglucagon is the 158-amino acid segment of preproglucagon without the n-terminal signal sequence. proglucagon is expressed in the pancreas; intestines; and the central nervous system. posttranslational processing of proglucagon is tissue-specific yielding numerous bioactive peptides.
  • Receptors, Glucagon

    cell surface receptors that bind glucagon with high affinity and trigger intracellular changes which influence the behavior of cells. activation of glucagon receptors causes a variety of effects; the best understood is the initiation of a complex enzymatic cascade in the liver which ultimately increases the availability of glucose to body organs.
  • Glyburide

    an antidiabetic sulfonylurea derivative with actions like those of chlorpropamide
  • Metformin

    a biguanide hypoglycemic agent used in the treatment of non-insulin-dependent diabetes mellitus not responding to dietary modification. metformin improves glycemic control by improving insulin sensitivity and decreasing intestinal absorption of glucose. (from martindale, the extra pharmacopoeia, 30th ed, p289)
  • Phenformin

    a biguanide hypoglycemic agent with actions and uses similar to those of metformin. although it is generally considered to be associated with an unacceptably high incidence of lactic acidosis, often fatal, it is still available in some countries. (from martindale, the extra pharmacopoeia, 30th ed, p290)
  • Tolazamide

    a sulphonylurea hypoglycemic agent with actions and uses similar to those of chlorpropamide.

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 hormones and their synthetic substitutes and antagonists, not elsewhere classified (T38). 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)

T38.3X6D 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 T38.3X6D to ICD-9-CM

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

Table of Drugs and Chemicals

The parent code T38.3X6 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
AcetohexamideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Antidiabetic NECT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Antidiabetic NEC
  »biguanide
T38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Antidiabetic NEC
  »biguanide
    »and sulfonyl combined
T38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Antidiabetic NEC
  »combined
T38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Antidiabetic NEC
  »sulfonylurea
T38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Biguanide derivatives, oralT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
BuforminT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
CarbutamideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
ChlorpropamideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
DBIT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
DiabineseT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
DymelorT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Extended insulin zinc suspensionT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
GlibenclamideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
GlibornurideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
GliclazideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
GlimidineT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
GlipizideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
GliquidoneT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
GlisolamideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
GlisoxepideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Globin zinc insulinT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
GlucagonT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
GlyburideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
GlyclopyramideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
GlycyclamideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Glymidine sodiumT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
IletinT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Insular tissue extractT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Insulin (amorphous) (globin) (isophane) (Lente) (NPH) (Semilente) (Ultralente)T38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Insulin (amorphous) (globin) (isophane) (Lente) (NPH) (Semilente) (Ultralente)
  »defalan
T38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Insulin (amorphous) (globin) (isophane) (Lente) (NPH) (Semilente) (Ultralente)
  »human
T38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Insulin (amorphous) (globin) (isophane) (Lente) (NPH) (Semilente) (Ultralente)
  »injection, soluble
T38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Insulin (amorphous) (globin) (isophane) (Lente) (NPH) (Semilente) (Ultralente)
  »injection, soluble
    »biphasic
T38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Insulin (amorphous) (globin) (isophane) (Lente) (NPH) (Semilente) (Ultralente)
  »intermediate acting
T38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Insulin (amorphous) (globin) (isophane) (Lente) (NPH) (Semilente) (Ultralente)
  »protamine zinc
T38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Insulin (amorphous) (globin) (isophane) (Lente) (NPH) (Semilente) (Ultralente)
  »slow acting
T38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Insulin (amorphous) (globin) (isophane) (Lente) (NPH) (Semilente) (Ultralente)
  »zinc
T38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Insulin (amorphous) (globin) (isophane) (Lente) (NPH) (Semilente) (Ultralente)
  »zinc
    »protamine injection
T38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Insulin (amorphous) (globin) (isophane) (Lente) (NPH) (Semilente) (Ultralente)
  »zinc
    »suspension (amorphous) (crystalline)
T38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Isophane insulinT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Lente lietin (insulin)T38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
MetforminT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Neutral insulin injectionT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
NPH lletin (insulin)T38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
OrinaseT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
PhenforminT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
PhenylethylbiguanideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
PZIT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Sulfonylurea derivatives, oralT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
TolazamideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Tolbutamide (sodium)T38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6

Patient Education


Diabetes Medicines

What is diabetes?

Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose comes from the foods you eat. The cells of your body need glucose for energy. A hormone called insulin helps the glucose get into your cells.

With type 1 diabetes, your body does not make insulin. With type 2 diabetes,your body does not make or use insulin well. Without enough insulin, glucose can't get into your cells as quickly as usual. The glucose builds up in your blood and causes high blood sugar levels.

What are the treatments for diabetes?

Treatments for diabetes can depend on the type. Common treatments include a diabetic meal plan, regular physical activity, and medicines. Some less common treatments are weight loss surgery for either type and an artificial pancreas or pancreatic islet transplantation for some people with type 1 diabetes.

Who needs diabetes medicines?

People with type 1 diabetes need to take a diabetes medicine called insulin to control their blood sugar.

Some people with type 2 diabetes can control their blood sugar with healthy food choices and physical activity. But for others, a diabetic meal plan and physical activity are not enough. They need to take diabetes medicines.

The kind of medicine you take depends on your type of diabetes, daily schedule, medicine costs, and any other health conditions that you have. Over time, you may need to take more than one diabetes medicine.

What are the types of medicines for type 1 diabetes?

If you have type 1 diabetes, you must take insulin because your body no longer makes it. There are different types of insulin that start to work at different speeds, and the effects of each last a different length of time. Your health care provider will measure your blood glucose to decide on the type of insulin. You may need to use more than one type.

You will also need to check your blood sugar at home. Your provider will tell you how often. The results of your blood sugar testing can help you make decisions about food, physical activity, and medicines.

You can take insulin several different ways. The most common are with a needle and syringe, an insulin pen, or an insulin pump. If you use a needle and syringe or a pen, you have to take insulin several times during the day, including with meals. An insulin pump gives you small, steady doses throughout the day. Less common ways to take insulin include inhalers, injection ports, and jet injectors.

In rare cases, taking insulin alone might not be enough to manage your blood sugar. Then you would need to take another diabetes medicine.

What are the types of medicines for type 2 diabetes?

There are several different medicines for type 2 diabetes. Each works in a different way. Many of them are pills. There are also medicines that you inject under your skin, such as insulin.

Over time, you may need more than one diabetes medicine to manage your blood sugar. You might add another diabetes medicine or switch to a combination medicine. A combination medicine contains more than one type of diabetes medicine in the same pill. Some people with type 2 diabetes take both pills and injections.

Even if you don't usually take insulin, you may need it at special times, such as during pregnancy or if you are in the hospital.

What else should I know about taking medicines for diabetes?

Even if you take medicines for diabetes, you still need to eat a healthy diet, stop smoking, take your other medicines, and get regular physical activity. These will help you manage your diabetes.

It is important to make sure that you understand your diabetes treatment plan. Talk to your provider about:

  • What your target blood sugar level is
  • What to do if your blood sugar gets too low or too high
  • Whether your diabetes medicines will affect other medicines you take
  • If you will have any side effects from the diabetes medicines

You should not change or stop your diabetes medicines on your own. Talk to your provider first.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases


[Learn More in MedlinePlus]

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


[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.