2024 ICD-10-CM Diagnosis Code T38.5X5D

Adverse effect of other estrogens and progestogens, subsequent encounter

ICD-10-CM Code:
T38.5X5D
ICD-10 Code for:
Adverse effect of oth estrogens and progestogens, 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)

T38.5X5D is a billable diagnosis code used to specify a medical diagnosis of adverse effect of other estrogens and progestogens, 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.

T38.5X5D 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 other estrogens and progestogens. 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:

  • 46,XX disorder of sex development caused by synthetic oral diethylstilbestrol
  • 46,XX disorder of sex development due to synthetic oral progestogen
  • Adverse reaction to cyproterone and/or ethinyl estradiol
  • Adverse reaction to cyproterone and/or ethinyl estradiol
  • Adverse reaction to estrogen and/or progesterone
  • Adverse reaction to polyestradiol
  • Allylestrenol adverse reaction
  • Autoimmune progesterone dermatitis
  • Clomiphene adverse reaction
  • Conjugated estrogens adverse reaction
  • Dienestrol adverse reaction
  • Dydrogesterone adverse reaction
  • Endometriosis of the spermatic cord following estrogen therapy
  • Estradiol adverse reaction
  • Estradiol implant adverse reaction
  • Estriol adverse reaction
  • Estrogen adverse reaction
  • Estrogen antagonist adverse reaction
  • Ethinylestradiol adverse reaction
  • Fosfestrol adverse reaction
  • Gestrinone adverse reaction
  • Gestronol adverse reaction
  • HRT side-effects
  • Hydroxyprogesterone adverse reaction
  • Medroxyprogesterone adverse reaction
  • Megestrol adverse reaction
  • Menopause monitoring status
  • Mestranol adverse reaction
  • Oral estradiol adverse reaction
  • Piperazine estrone sulfate adverse reaction
  • Progesterone adverse reaction
  • Progestogen adverse reaction
  • Quinestradol adverse reaction
  • Quinestrol adverse reaction
  • Stilbestrol adverse reaction
  • Stilbestrol-related vaginal adenosis
  • Topical estradiol adverse reaction
  • Vaginal adenosis

Clinical Classification

Clinical Information

  • Vaginal Adenosis

    the presence of glandular structures in the vagina.

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)

T38.5X5D 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 T38.5X5D 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 T38.5X5 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
AllylestrenolT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
Anhydrohydroxy-progesteroneT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
ChlormadinoneT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
ChlorotrianiseneT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
ChlortrianiseneT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
ClomifeneT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
ClomipheneT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
Conjugated estrogenic substancesT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
DelalutinT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
DemegestoneT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
DesogestrelT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
DiaethylstilboestrolumT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
DienestrolT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
DienoestrolT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
DiethylstilbestrolT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
DiethylstilboestrolT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
DimestrolT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
DimethisteroneT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
DydrogesteroneT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
EpiestriolT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
EpimestrolT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
EstradiolT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
Estradiol
  »with testosterone
T38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
Estradiol
  »benzoate
T38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
EstriolT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
EstrogenT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
Estrogen
  »with progesterone
T38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
Estrogen
  »conjugated
T38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
EstroneT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
EstropipateT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
Ethinylestradiol, ethinyloestradiolT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
Ethinylestradiol, ethinyloestradiol
  »with
T38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
Ethinylestradiol, ethinyloestradiol
  »with
    »levonorgestrel
T38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
Ethinylestradiol, ethinyloestradiol
  »with
    »norethisterone
T38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
EthisteroneT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
FosfestrolT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
Gestonorone caproateT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
HexestrolT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
HexoestrolT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
HydroxyestroneT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
HydroxyprogesteroneT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
Hydroxyprogesterone
  »caproate
T38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
IsopregnenoneT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
Lipo-LutinT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
LutocylolT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
LutromoneT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
MedrogestoneT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
Medroxyprogesterone acetate (depot)T38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
MegestrolT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
MestranolT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
MethallenestrilT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
MethallenoestrilT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
MethylestrenoloneT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
NomegestrolT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
NoretynodrelT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
NormethandroneT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
OestradiolT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
OestriolT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
OestrogenT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
OestroneT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
OvarianT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
Ovarian
  »hormone
T38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
Ovarian
  »stimulant
T38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
OxendoloneT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
Polyestradiol phosphateT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
Polyoestradiol phosphateT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
PregnandiolT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
PregneninoloneT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
PremarinT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
ProgesteroneT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
ProgestinT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
Progestin
  »oral contraceptive
T38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
Progestogen NECT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
ProgestoneT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
ProlutonT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
PromegestoneT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
ProveraT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
QuinestradiolT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
QuinestradolT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
QuinestrolT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
StilbestrolT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
StilboestrolT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6
TaceT38.5X1T38.5X2T38.5X3T38.5X4T38.5X5T38.5X6

Patient Education


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.