2024 ICD-10-CM Diagnosis Code T38.4X5D

Adverse effect of oral contraceptives, subsequent encounter

ICD-10-CM Code:
T38.4X5D
ICD-10 Code for:
Adverse effect of oral contraceptives, 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 hormones and their synthetic substitutes and antagonists, not elsewhere classified
        (T38)

T38.4X5D is a billable diagnosis code used to specify a medical diagnosis of adverse effect of oral contraceptives, 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.

T38.4X5D is a subsequent encounter code, includes a 7th character and should be used after the patient has completed active treatment for a condition like adverse effect of oral contraceptives. 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.

Approximate Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

  • Adverse reaction to oral contraceptive
  • Chorea caused by oral contraceptive
  • Drug-induced chorea
  • Ethynodiol diacetate adverse reaction
  • Gingival disease caused by oral contraceptive use
  • Gingival enlargement exacerbated by oral contraceptive
  • Headache caused by drug
  • Headache caused by oral contraceptive pill
  • Hypertension induced by oral contraceptive pill
  • Hypertension secondary to drug
  • Levonorgestrel adverse reaction
  • Migraine due to estrogen contraceptive
  • Norethisterone adverse reaction
  • Oral contraceptive intolerance
  • Postpill amenorrhea
  • Secondary amenorrhea

Clinical Classification

Clinical Information

  • Secondary Amenorrhea

    the cessation of menstruation for six months or more in a female that is not pregnant, breastfeeding or menopausal.

Coding Guidelines

When coding an adverse effect of a drug that has been correctly prescribed and properly administered, assign the appropriate code for the nature of the adverse effect followed by the appropriate code for the adverse effect of the drug.

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)

T38.4X5D 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 T38.4X5D to ICD-9-CM

  • ICD-9-CM Code: V58.89 - Other specfied aftercare
    Approximate Flag - The approximate mapping means there is not an exact match between the ICD-10 and ICD-9 codes and the mapped code is not a precise representation of the original code.

Table of Drugs and Chemicals

The parent code T38.4X5 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
Antifertility pillT38.4X1T38.4X2T38.4X3T38.4X4T38.4X5T38.4X6
Contraceptive (oral)T38.4X1T38.4X2T38.4X3T38.4X4T38.4X5T38.4X6
Contraceptive (oral)
  »vaginal
T38.4X1T38.4X2T38.4X3T38.4X4T38.4X5T38.4X6
DemulenT38.4X1T38.4X2T38.4X3T38.4X4T38.4X5T38.4X6
EnovidT38.4X1T38.4X2T38.4X3T38.4X4T38.4X5T38.4X6
EthynodiolT38.4X1T38.4X2T38.4X3T38.4X4T38.4X5T38.4X6
Ethynodiol
  »with mestranol diacetate
T38.4X1T38.4X2T38.4X3T38.4X4T38.4X5T38.4X6
EtinodiolT38.4X1T38.4X2T38.4X3T38.4X4T38.4X5T38.4X6
EtynodiolT38.4X1T38.4X2T38.4X3T38.4X4T38.4X5T38.4X6
LevonorgestrelT38.4X1T38.4X2T38.4X3T38.4X4T38.4X5T38.4X6
Levonorgestrel
  »with ethinylestradiol
T38.4X1T38.4X2T38.4X3T38.4X4T38.4X5T38.4X6
LynestrenolT38.4X1T38.4X2T38.4X3T38.4X4T38.4X5T38.4X6
NorethindroneT38.4X1T38.4X2T38.4X3T38.4X4T38.4X5T38.4X6
Norethisterone (acetate) (enantate)T38.4X1T38.4X2T38.4X3T38.4X4T38.4X5T38.4X6
Norethisterone (acetate) (enantate)
  »with ethinylestradiol
T38.4X1T38.4X2T38.4X3T38.4X4T38.4X5T38.4X6
NorgestrelT38.4X1T38.4X2T38.4X3T38.4X4T38.4X5T38.4X6
NorgestrienoneT38.4X1T38.4X2T38.4X3T38.4X4T38.4X5T38.4X6
NorlestrinT38.4X1T38.4X2T38.4X3T38.4X4T38.4X5T38.4X6
NorlutinT38.4X1T38.4X2T38.4X3T38.4X4T38.4X5T38.4X6
OraconT38.4X1T38.4X2T38.4X3T38.4X4T38.4X5T38.4X6
Oral contraceptivesT38.4X1T38.4X2T38.4X3T38.4X4T38.4X5T38.4X6
Ortho-NovumT38.4X1T38.4X2T38.4X3T38.4X4T38.4X5T38.4X6
OvralT38.4X1T38.4X2T38.4X3T38.4X4T38.4X5T38.4X6
OvulenT38.4X1T38.4X2T38.4X3T38.4X4T38.4X5T38.4X6
QuingestanolT38.4X1T38.4X2T38.4X3T38.4X4T38.4X5T38.4X6

Patient Education


Birth Control

What is birth control?

Birth control, also known as contraception, is the use of medicines, devices, or surgery to prevent pregnancy. There are many different types. Some are reversable, while others are permanent. Some types can also help prevent sexually transmitted diseases (STDs).

What are the different types of birth control?

There are several different types of birth control, and they work in different ways:

Barrier methods
Male condom A thin sheath that covers the penis to collect sperm and prevent it from entering the woman's body. Condoms that are made of latex and polyurethane can help prevent STDs.
Female condom A thin, flexible plastic pouch. Part of the condom is inserted into the vagina before intercourse to prevent sperm from entering the uterus. The uterus, or womb, is the place where the baby grows during pregnancy. Female condoms can also help prevent STDs.
Contraceptive sponge A small sponge that you put into the vagina to cover the cervix (the opening of the uterus). The sponge also contains a spermicide to kill sperm.
Spermicide A substance that can kill sperm cells. It comes in a foam, jelly, cream, suppository, or film. You put it into the vagina near the uterus. Spermicide can be used alone or with a diaphragm or cervical cap.
Diaphragm and cervical cap Cups that are placed inside the vagina to cover the cervix. They may be used with spermicide. They come in different sizes, so it's important to see your health care provider to figure out which size works best for you.
Hormonal methods
Oral contraceptives ("the pill") Pills that a woman takes every day. They may contain only progestin or both progestin and estrogen.
Contraceptive patch A patch that a woman puts on her skin each week. The patch releases hormones into the bloodstream.
Vaginal ring A thin, flexible ring. The woman inserts the ring into the vagina, where it continually releases hormones for three weeks. She takes it out for the fourth week. After that week, she puts in a new ring.
Injectable birth control An injection of a hormone that a woman gets once every three months. This is done in your provider's office.
Implant A single, thin rod that a provider inserts under the skin of a women's upper arm. It is done in your provider's office. The implant can last for four years.
Long-acting reversible contraceptives (LARCs)
Intrauterine device (IUD) A small, T-shaped device that a provider inserts into the uterus. This is done in the provider's office. IUDs can last from 3 to 10 years. There are two types: hormonal IUDs and copper IUDs.
Sterilization
Tubal ligation A surgery that prevents a woman from getting pregnant. It is permanent.
Vasectomy A surgery that prevents a man from getting someone pregnant. It is permanent.

What are some other forms of pregnancy prevention?

There are some types of pregnancy prevention that do not involve medicines, devices, or surgery:

Other forms of pregnancy prevention
Fertility awareness-based methods They are also called natural rhythm methods. They involve tracking the woman's fertility cycle and avoiding sex or using barrier methods on the days when she is most likely to get pregnant. This method may have higher pregnancy rates than other types.
Lactational amenorrhea method (LAM) A form of natural birth control for breastfeeding mothers. It relies on the new mother feeding her baby only breastmilk for up to six months and having no periods or spotting during that time.
Withdrawal During intercourse, the penis is pulled out of the vagina before ejaculation. The goal is to keep sperm from entering the vagina . But the sperm can leak out before the penis is pulled out, so this method has higher pregnancy rates than other types.

What is emergency contraception?

Emergency contraception is not a regular method of birth control. But it can be used to prevent pregnancy after unprotected intercourse or if a condom breaks. There are two types:

  • Copper IUD, which is a small, T-shaped device that a provider inserts into the within 120 hours of unprotected intercourse.
  • Emergency contraceptive pills (ECPs), which are hormonal pills which the woman takes as soon as possible after unprotected intercourse.

What else should I know about birth control?

When deciding which birth control type is right for you, there are many different factors to consider:

  • Do you want to have children someday? How soon?
  • Do you have any health conditions?
  • How often do you have sex?
  • How many sex partners do you have?
  • Do you also need protection from HIV and other STDs?
  • How well does the birth control method work?
  • Are there any side effects?
  • Will you be able to use it correctly every time?
  • How much does it cost?

Your provider can answer your questions about birth control to help you select the best type for you.

NIH: National Institute of Child Health and Human Development


[Learn More in MedlinePlus]

Drug Reactions

Most of the time, medicines make our lives better. They reduce aches and pains, fight infections, and control problems such as high blood pressure or diabetes. But medicines can also cause unwanted reactions, such as drug interactions, side effects, and allergies.

What is a drug interaction?

A drug interaction is a change in the way a drug acts in the body when taken with certain other drugs, foods, or supplements or when taken while you have certain medical conditions. Examples include:

  • Two drugs, such as aspirin and blood thinners
  • Drugs and food, such as statins and grapefruit
  • Drugs and supplements, such as gingko and blood thinners
  • Drugs and medical conditions, such as aspirin and peptic ulcers

Interactions could cause a drug to be more or less effective, cause side effects, or change the way one or both drugs work.

What are side effects?

Side effects are unwanted, usually unpleasant, effects caused by medicines. Most are mild, such as a stomachache, dry mouth, or drowsiness, and go away after you stop taking the medicine. Others can be more serious. Sometimes a drug can interact with a disease that you have and cause a side effect. For example, if you have a heart condition, certain decongestants can cause you to have a rapid heartbeat.

What are drug allergies?

Drug allergies are another type of reaction. They can range from mild to life-threatening. Skin reactions, such as hives and rashes, are the most common type. Anaphylaxis, a serious allergic reaction, is less common.

How can I stay safe when taking medicines?

When you start a new prescription or over-the-counter medicine, make sure you understand how to take it correctly. Know which other medicines, foods, and supplements you need to avoid. Always talk to your health care provider or pharmacist if you have questions about your medicines.


[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.