2024 ICD-10-CM Diagnosis Code T38.4X6A

Underdosing of oral contraceptives, initial encounter

ICD-10-CM Code:
T38.4X6A
ICD-10 Code for:
Underdosing of oral contraceptives, initial 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)

T38.4X6A is a billable diagnosis code used to specify a medical diagnosis of underdosing of oral contraceptives, initial 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.

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.

T38.4X6A is an initial encounter code, includes a 7th character and should be used while the patient is receiving active treatment for a condition like underdosing of oral contraceptives. According to ICD-10-CM Guidelines an "initial encounter" doesn't necessarily means "initial visit". The 7th character should be used when the patient is undergoing active treatment regardless if new or different providers saw the patient over the course of a treatment. The appropriate 7th character codes should also be used even if the patient delayed seeking treatment for a condition.

Clinical Classification

Clinical Information

  • Levonorgestrel

    a synthetic progestational hormone with actions similar to those of progesterone and about twice as potent as its racemic or (+-)-isomer (norgestrel). it is used for contraception, control of menstrual disorders, and treatment of endometriosis.
  • Lynestrenol

    a synthetic progestational hormone used often in mixtures with estrogens as an oral contraceptive (contraceptives, oral).
  • Norethindrone

    a synthetic progestational hormone with actions similar to those of progesterone but functioning as a more potent inhibitor of ovulation. it has weak estrogenic and androgenic properties. the hormone has been used in treating amenorrhea, functional uterine bleeding, endometriosis, and for contraception.
  • Norethindrone Acetate

    acetate ester of norethindrone that is used as a long-term contraceptive (contraceptive agents).
  • Ethinyl Estradiol-Norgestrel Combination

    ethinyl estradiol and norgestrel given in fixed proportions.
  • Norgestrel

    a synthetic progestational agent with actions similar to those of progesterone. this racemic or (+-)-form has about half the potency of the levo form (levonorgestrel). norgestrel is used as a contraceptive, ovulation inhibitor, and for the control of menstrual disorders and endometriosis.
  • Norgestrienone

    a synthetic steroid with progestational and contraceptive activities.

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.

Convert T38.4X6A to ICD-9-CM

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

Table of Drugs and Chemicals

The parent code T38.4X6 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]

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.