2024 ICD-10-CM Diagnosis Code T38.6X4D

Poisoning by antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, undetermined, subsequent encounter

ICD-10-CM Code:
T38.6X4D
ICD-10 Code for:
Poisn by antigonadtr/antiestr/antiandrg, NEC, undet, 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)

T38.6X4D is a billable diagnosis code used to specify a medical diagnosis of poisoning by antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, undetermined, 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.

T38.6X4D is a subsequent encounter code, includes a 7th character and should be used after the patient has completed active treatment for a condition like poisoning by antigonadotrophins antiestrogens antiandrogens not elsewhere classified undetermined. 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

  • Cyproterone

    an anti-androgen that, in the form of its acetate (cyproterone acetate), also has progestational properties. it is used in the treatment of hypersexuality in males, as a palliative in prostatic carcinoma, and, in combination with estrogen, for the therapy of severe acne and hirsutism in females.
  • Cyproterone Acetate

    an agent with anti-androgen and progestational properties. it shows competitive binding with dihydrotestosterone at androgen receptor sites.
  • Danazol

    a synthetic steroid with antigonadotropic and anti-estrogenic activities that acts as an anterior pituitary suppressant by inhibiting the pituitary output of gonadotropins. it possesses some androgenic properties. danazol has been used in the treatment of endometriosis and some benign breast disorders.
  • Flutamide

    an antiandrogen with about the same potency as cyproterone in rodent and canine species.
  • Mifepristone

    a progestational and glucocorticoid hormone antagonist. its inhibition of progesterone induces bleeding during the luteal phase and in early pregnancy by releasing endogenous prostaglandins from the endometrium or decidua. as a glucocorticoid receptor antagonist, the drug has been used to treat hypercortisolism in patients with nonpituitary cushing syndrome.
  • Nafoxidine

    an estrogen antagonist that has been used in the treatment of breast cancer.
  • Tamoxifen

    one of the selective estrogen receptor modulators with tissue-specific activities. tamoxifen acts as an anti-estrogen (inhibiting agent) in the mammary tissue, but as an estrogen (stimulating agent) in cholesterol metabolism, bone density, and cell proliferation in the endometrium.
  • Toremifene

    a first generation selective estrogen receptor modulator (serm). like tamoxifen, it is an estrogen agonist for bone tissue and cholesterol metabolism but is antagonistic on mammary and uterine tissue.

Coding Guidelines

When coding a poisoning or reaction to the improper use of a medication (e.g., overdose, wrong substance given or taken in error, wrong route of administration), first assign the appropriate code from categories T36-T50. The poisoning codes have an associated intent as their 5th or 6th character (accidental, intentional self-harm, assault and undetermined. If the intent of the poisoning is unknown or unspecified, code the intent as accidental intent. The undetermined intent is only for use if the documentation in the record specifies that the intent cannot be determined. Use additional code(s) for all manifestations of poisonings.

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

Present on Admission (POA)

T38.6X4D 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 T38.6X4D 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 T38.6X4 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
Antiandrogen NECT38.6X1T38.6X2T38.6X3T38.6X4T38.6X5T38.6X6
Antiestrogen NECT38.6X1T38.6X2T38.6X3T38.6X4T38.6X5T38.6X6
Antigonadotrophin NECT38.6X1T38.6X2T38.6X3T38.6X4T38.6X5T38.6X6
CyproteroneT38.6X1T38.6X2T38.6X3T38.6X4T38.6X5T38.6X6
DanazolT38.6X1T38.6X2T38.6X3T38.6X4T38.6X5T38.6X6
FlutamideT38.6X1T38.6X2T38.6X3T38.6X4T38.6X5T38.6X6
MifepristoneT38.6X1T38.6X2T38.6X3T38.6X4T38.6X5T38.6X6
NafoxidineT38.6X1T38.6X2T38.6X3T38.6X4T38.6X5T38.6X6
NilutamideT38.6X1T38.6X2T38.6X3T38.6X4T38.6X5T38.6X6
OrmeloxifeneT38.6X1T38.6X2T38.6X3T38.6X4T38.6X5T38.6X6
TaleranolT38.6X1T38.6X2T38.6X3T38.6X4T38.6X5T38.6X6
TamoxifenT38.6X1T38.6X2T38.6X3T38.6X4T38.6X5T38.6X6
ToremifeneT38.6X1T38.6X2T38.6X3T38.6X4T38.6X5T38.6X6

Patient Education


Poisoning

A poison is any substance that is harmful to your body. You might swallow it, inhale it, inject it, or absorb it through your skin. Any substance can be poisonous if too much is taken. Poisons can include:

  • Prescription or over-the-counter medicines taken in doses that are too high
  • Overdoses of illegal drugs
  • Carbon monoxide from gas appliances
  • Household products, such as laundry powder or furniture polish
  • Pesticides
  • Indoor or outdoor plants
  • Metals such as lead and mercury

The effects of poisoning range from short-term illness to brain damage, coma, and death. To prevent poisoning it is important to use and store products exactly as their labels say. Keep dangerous products where children can't get to them. Treatment for poisoning depends on the type of poison. If you suspect someone has been poisoned, call your local poison control center at 1-800-222-1222 right away.


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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.