Version 2024

2024 ICD-10-CM Diagnosis Code T38.6X5S

Adverse effect of antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, sequela

ICD-10-CM Code:: T38.6X5S
ICD-10 Code for:: Advrs effect of antigonadtr/antiestr/antiandrg, NEC, sequela
Is Billable?: Yes - Valid for Submission
Chronic Condition Indicator: ^[1]: Not chronic
Code Navigator:

Code Information
Approximate Synonyms
Clinical Classification
Clinical Information
Coding Guidelines
Tabular List of Diseases and Injuries
Code Edits
Diagnostic Related Groups Mapping
Present on Admission (POA)
Convert to ICD-9 Code
Table of Drugs and Chemicals
Patient Education
Other Codes Used Similar Conditions
Code History

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)

T38.6X5S is a billable diagnosis code used to specify a medical diagnosis of adverse effect of antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, sequela. 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.

T38.6X5S is a sequela code, includes a 7th character and should be used for complications that arise as a direct result of a condition like adverse effect of antigonadotrophins antiestrogens antiandrogens not elsewhere classified. According to ICD-10-CM Guidelines a "sequela" code should be used for chronic or residual conditions that are complications of an initial acute disease, illness or injury. The most common sequela is pain. Usually, two diagnosis codes are needed when reporting sequela. The first code describes the nature of the sequela while the second code describes the sequela or late effect.

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 cyproterone and/or ethinyl estradiol
Adverse reaction to cyproterone and/or ethinyl estradiol
Adverse reaction to oxytocic agents
Aminoglutethimide adverse reaction
Anti-androgens adverse reaction
Cyproterone adverse reaction
Danazol adverse reaction
Drug-induced flushing
Drug-induced flushing
Estrogen antagonist adverse reaction
Estrogen antagonist adverse reaction
Estrogen antagonist adverse reaction
Estrogen antagonist adverse reaction
Estrogen antagonist adverse reaction
Estrogen antagonist adverse reaction
Finasteride adverse reaction
Flutamide adverse reaction
Formestane adverse reaction
Hot flash caused by aromatase inhibitor
Hot flash caused by tamoxifen
Hot flash due to medication
Hot flash due to medication
Mifepristone adverse reaction
Retinopathy of left eye caused by tamoxifen
Retinopathy of right eye caused by tamoxifen
Tamoxifen adverse reaction
Tamoxifen adverse reaction
Tamoxifen adverse reaction
Tamoxifen adverse reaction
Tamoxifen adverse reaction
Tamoxifen retinopathy
Tamoxifen retinopathy
Tamoxifen retinopathy

Clinical Classification

Clinical Category is Poisoning/toxic effect/adverse effects/underdosing, sequela
CCSR Category Code: INJ075
Inpatient Default CCSR: X - Not applicable.
Outpatient Default CCSR: Y - Yes, default outpatient assignment for principal diagnosis or first-listed diagnosis.

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 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.

T38.6X5S is grouped with Diagnostic Related Groups - MS-DRG Mapping

Diagnostic Related Groups (DRGs) are a classification system used to group together diagnosis codes for the purpose of reimbursement and healthcare management. DRGs are used to standardize the way hospitals and other providers are paid for inpatient services. In this system patients are grouped together based on their principal diagnosis in areas referred to as Major Diagnostic Categories (MDC). Once a patient is assigned a particular diagnostic category, providers receive a predetermined payment rate for the services rendered. This reimbursement rate is often fixed and is meant to cover the cost of care for that patient. Reimbursement is also affected by the relative weight of a diagnostic related group based on the severity of a patient's illness and the associated cost of care during hospitalization.

Diagnostic related groups encourage healthcare providers to focus on quality and efficiency in patient care while managing costs effectively. The diagnosis code is present in the following groups for version MS-DRG V41.0 applicable from 10/01/2023 through 09/30/2024.

MS-DRG	MS-DRG Title	MCD	Relative Weight
922	OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC	21	1.7449
923	OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC	21	1.0114

The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.

Present on Admission (POA)

T38.6X5S 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 Indicator	Reason for Code	CMS will pay the CC/MCC DRG?
Y	Diagnosis was present at time of inpatient admission.	YES
N	Diagnosis was not present at time of inpatient admission.	NO
U	Documentation insufficient to determine if the condition was present at the time of inpatient admission.	NO
W	Clinically undetermined - unable to clinically determine whether the condition was present at the time of inpatient admission.	YES
1	Unreported/Not used - Exempt from POA reporting.	NO

Convert T38.6X5S to ICD-9-CM

ICD-9-CM Code: 909.5 - Lte efct advrs efct drug
Combination Flag - Multiple codes are needed to describe the source diagnosis code. Correct coding should be done based on contextual judgment.
ICD-9-CM Code: E932.9 - Adv eff hormones NEC/NOS
Combination Flag - Multiple codes are needed to describe the source diagnosis code. Correct coding should be done based on contextual judgment.

Table of Drugs and Chemicals

The parent code T38.6X5 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.

Filter table of drugs and chemicals:

Substance	Poisoning Accidental (unintentional)	Poisoning Accidental (self-harm)	Poisoning Assault	Poisoning Undetermined	Adverse effect	Underdosing
Antiandrogen NEC	T38.6X1	T38.6X2	T38.6X3	T38.6X4	T38.6X5	T38.6X6
Antiestrogen NEC	T38.6X1	T38.6X2	T38.6X3	T38.6X4	T38.6X5	T38.6X6
Antigonadotrophin NEC	T38.6X1	T38.6X2	T38.6X3	T38.6X4	T38.6X5	T38.6X6
Cyproterone	T38.6X1	T38.6X2	T38.6X3	T38.6X4	T38.6X5	T38.6X6
Danazol	T38.6X1	T38.6X2	T38.6X3	T38.6X4	T38.6X5	T38.6X6
Flutamide	T38.6X1	T38.6X2	T38.6X3	T38.6X4	T38.6X5	T38.6X6
Mifepristone	T38.6X1	T38.6X2	T38.6X3	T38.6X4	T38.6X5	T38.6X6
Nafoxidine	T38.6X1	T38.6X2	T38.6X3	T38.6X4	T38.6X5	T38.6X6
Nilutamide	T38.6X1	T38.6X2	T38.6X3	T38.6X4	T38.6X5	T38.6X6
Ormeloxifene	T38.6X1	T38.6X2	T38.6X3	T38.6X4	T38.6X5	T38.6X6
Taleranol	T38.6X1	T38.6X2	T38.6X3	T38.6X4	T38.6X5	T38.6X6
Tamoxifen	T38.6X1	T38.6X2	T38.6X3	T38.6X4	T38.6X5	T38.6X6
Toremifene	T38.6X1	T38.6X2	T38.6X3	T38.6X4	T38.6X5	T38.6X6

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]

Other ICD-10-CM Codes Commonly Used for Similar Conditions

Filter related codes list:

T38 Poisoning by, adverse effect of and underdosing of hormones and their synthetic substitutes and antagonists, not elsewhere classified.
T38.0 Poisoning by, adverse effect of and underdosing of glucocorticoids and synthetic analogues.
T38.0X Poisoning by, adverse effect of and underdosing of glucocorticoids and synthetic analogues.
T38.0X1 Poisoning by glucocorticoids and synthetic analogues, accidental (unintentional).
T38.0X1A Poisoning by glucocorticoids and synthetic analogues, accidental (unintentional), initial encounter.
T38.0X1D Poisoning by glucocorticoids and synthetic analogues, accidental (unintentional), subsequent encounter.
T38.0X1S Poisoning by glucocorticoids and synthetic analogues, accidental (unintentional), sequela.
T38.0X2 Poisoning by glucocorticoids and synthetic analogues, intentional self-harm.
T38.0X2A Poisoning by glucocorticoids and synthetic analogues, intentional self-harm, initial encounter.
T38.0X2D Poisoning by glucocorticoids and synthetic analogues, intentional self-harm, subsequent encounter.
T38.0X2S Poisoning by glucocorticoids and synthetic analogues, intentional self-harm, sequela.
T38.0X3 Poisoning by glucocorticoids and synthetic analogues, assault.
T38.0X3A Poisoning by glucocorticoids and synthetic analogues, assault, initial encounter.
T38.0X3D Poisoning by glucocorticoids and synthetic analogues, assault, subsequent encounter.
T38.0X3S Poisoning by glucocorticoids and synthetic analogues, assault, sequela.
T38.0X4 Poisoning by glucocorticoids and synthetic analogues, undetermined.
T38.0X4A Poisoning by glucocorticoids and synthetic analogues, undetermined, initial encounter.
T38.0X4D Poisoning by glucocorticoids and synthetic analogues, undetermined, subsequent encounter.
T38.0X4S Poisoning by glucocorticoids and synthetic analogues, undetermined, sequela.
T38.0X5 Adverse effect of glucocorticoids and synthetic analogues.
T38.0X5A Adverse effect of glucocorticoids and synthetic analogues, initial encounter.
T38.0X5D Adverse effect of glucocorticoids and synthetic analogues, subsequent encounter.
T38.0X5S Adverse effect of glucocorticoids and synthetic analogues, sequela.
T38.0X6 Underdosing of glucocorticoids and synthetic analogues.
T38.0X6A Underdosing of glucocorticoids and synthetic analogues, initial encounter.
T38.0X6D Underdosing of glucocorticoids and synthetic analogues, subsequent encounter.
T38.0X6S Underdosing of glucocorticoids and synthetic analogues, sequela.
T38.1 Poisoning by, adverse effect of and underdosing of thyroid hormones and substitutes.
T38.1X Poisoning by, adverse effect of and underdosing of thyroid hormones and substitutes.
T38.1X1 Poisoning by thyroid hormones and substitutes, accidental (unintentional).
T38.1X1A Poisoning by thyroid hormones and substitutes, accidental (unintentional), initial encounter.
T38.1X1D Poisoning by thyroid hormones and substitutes, accidental (unintentional), subsequent encounter.
T38.1X1S Poisoning by thyroid hormones and substitutes, accidental (unintentional), sequela.
T38.1X2 Poisoning by thyroid hormones and substitutes, intentional self-harm.
T38.1X2A Poisoning by thyroid hormones and substitutes, intentional self-harm, initial encounter.
T38.1X2D Poisoning by thyroid hormones and substitutes, intentional self-harm, subsequent encounter.
T38.1X2S Poisoning by thyroid hormones and substitutes, intentional self-harm, sequela.
T38.1X3 Poisoning by thyroid hormones and substitutes, assault.
T38.1X3A Poisoning by thyroid hormones and substitutes, assault, initial encounter.
T38.1X3D Poisoning by thyroid hormones and substitutes, assault, subsequent encounter.
T38.1X3S Poisoning by thyroid hormones and substitutes, assault, sequela.
T38.1X4 Poisoning by thyroid hormones and substitutes, undetermined.
T38.1X4A Poisoning by thyroid hormones and substitutes, undetermined, initial encounter.
T38.1X4D Poisoning by thyroid hormones and substitutes, undetermined, subsequent encounter.
T38.1X4S Poisoning by thyroid hormones and substitutes, undetermined, sequela.
T38.1X5 Adverse effect of thyroid hormones and substitutes.
T38.1X5A Adverse effect of thyroid hormones and substitutes, initial encounter.
T38.1X5D Adverse effect of thyroid hormones and substitutes, subsequent encounter.
T38.1X5S Adverse effect of thyroid hormones and substitutes, sequela.
T38.1X6 Underdosing of thyroid hormones and substitutes.
T38.1X6A Underdosing of thyroid hormones and substitutes, initial encounter.

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.