2024 ICD-10-CM Diagnosis Code T36.1X5A

Adverse effect of cephalosporins and other beta-lactam antibiotics, initial encounter

ICD-10-CM Code:
T36.1X5A
ICD-10 Code for:
Adverse effect of cephalospor/oth beta-lactm antibiot, init
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 systemic antibiotics
        (T36)

T36.1X5A is a billable diagnosis code used to specify a medical diagnosis of adverse effect of cephalosporins and other beta-lactam antibiotics, 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.

T36.1X5A is an initial encounter code, includes a 7th character and should be used while the patient is receiving active treatment for a condition like adverse effect of cephalosporins and other beta-lactam antibiotics. 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.

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 amoxicillin and/or clavulanic acid
  • Adverse reaction to clavulanic acid and/or ticarcillin
  • Adverse reaction to piperacillin and/or tazobactam
  • Aztreonam adverse reaction
  • Beta lactam adverse reaction
  • Carbapenem adverse reaction
  • Cefaclor adverse reaction
  • Cefadroxil adverse reaction
  • Cefixime adverse reaction
  • Cefodizime adverse reaction
  • Cefotaxime adverse reaction
  • Cefoxitin adverse reaction
  • Cefpirome adverse reaction
  • Cefpodoxime adverse reaction
  • Cefsulodin adverse reaction
  • Ceftazidime adverse reaction
  • Ceftibuten adverse reaction
  • Ceftizoxime adverse reaction
  • Ceftriaxone adverse reaction
  • Cefuroxime adverse reaction
  • Cephalexin adverse reaction
  • Cephalosporin adverse reaction
  • Cephalothin adverse reaction
  • Cephamandole adverse reaction
  • Cephamycin adverse reaction
  • Cephazolin adverse reaction
  • Cephradine adverse reaction
  • First generation cephalosporin adverse reaction
  • Fourth generation cephalosporin adverse reaction
  • Latamoxef adverse reaction
  • Monobactam adverse reaction
  • Second generation cephalosporin adverse reaction
  • Third generation cephalosporin adverse reaction

Clinical Classification

Clinical Information

  • Aztreonam

    a monocyclic beta-lactam antibiotic originally isolated from chromobacterium violaceum. it is resistant to beta-lactamases and is used in gram-negative infections, especially of the meninges, bladder, and kidneys. it may cause a superinfection with gram-positive organisms.
  • Cefaclor

    semisynthetic, broad-spectrum antibiotic derivative of cephalexin.
  • Cefadroxil

    long-acting, broad-spectrum, water-soluble, cephalexin derivative.
  • Cefamandole

    semisynthetic wide-spectrum cephalosporin with prolonged action, probably due to beta-lactamase resistance. it is used also as the nafate.
  • Cefatrizine

    orally active semisynthetic cephalosporin antibiotic with broad-spectrum activity.
  • Cefazolin

    a semisynthetic cephalosporin analog with broad-spectrum antibiotic action due to inhibition of bacterial cell wall synthesis. it attains high serum levels and is excreted quickly via the urine.
  • Cefixime

    a third-generation cephalosporin antibiotic that is stable to hydrolysis by beta-lactamases.
  • Cefmenoxime

    a cephalosporin antibiotic that is administered intravenously or intramuscularly. it is active against most common gram-positive and gram-negative microorganisms, is a potent inhibitor of enterobacteriaceae, and is highly resistant to hydrolysis by beta-lactamases. the drug has a high rate of efficacy in many types of infection and to date no severe side effects have been noted.
  • Cefmetazole

    a semisynthetic cephamycin antibiotic with a broad spectrum of activity against both gram-positive and gram-negative microorganisms. it has a high rate of efficacy in many types of infection and to date no severe side effects have been noted.
  • Cefonicid

    a second-generation cephalosporin administered intravenously or intramuscularly. its bactericidal action results from inhibition of cell wall synthesis. it is used for urinary tract infections, lower respiratory tract infections, and soft tissue and bone infections.
  • Cefoperazone

    semisynthetic broad-spectrum cephalosporin with a tetrazolyl moiety that is resistant to beta-lactamase. it may be used to treat pseudomonas infections.
  • Cefotaxime

    semisynthetic broad-spectrum cephalosporin.
  • Cefotetan

    a semisynthetic cephamycin antibiotic that is administered intravenously or intramuscularly. the drug is highly resistant to a broad spectrum of beta-lactamases and is active against a wide range of both aerobic and anaerobic gram-positive and gram-negative microorganisms.
  • Cefotiam

    one of the cephalosporins that has a broad spectrum of activity against both gram-positive and gram-negative microorganisms.
  • Cefoxitin

    a semisynthetic cephamycin antibiotic resistant to beta-lactamase.
  • Cefsulodin

    a pyridinium-substituted semisynthetic, broad-spectrum antibacterial used especially for pseudomonas infections in debilitated patients.
  • Ceftazidime

    semisynthetic, broad-spectrum antibacterial derived from cephaloridine and used especially for pseudomonas and other gram-negative infections in debilitated patients.
  • Ceftizoxime

    a semisynthetic cephalosporin antibiotic which can be administered intravenously or by suppository. the drug is highly resistant to a broad spectrum of beta-lactamases and is active against a wide range of both aerobic and anaerobic gram-positive and gram-negative organisms. it has few side effects and is reported to be safe and effective in aged patients and in patients with hematologic disorders.
  • Ceftriaxone

    a broad-spectrum cephalosporin antibiotic and cefotaxime derivative with a very long half-life and high penetrability to meninges, eyes and inner ears.
  • Cefuroxime

    broad-spectrum cephalosporin antibiotic resistant to beta-lactamase. it has been proposed for infections with gram-negative and gram-positive organisms, gonorrhea, and haemophilus.
  • Cephalexin

    a semisynthetic cephalosporin antibiotic with antimicrobial activity similar to that of cephaloridine or cephalothin, but somewhat less potent. it is effective against both gram-positive and gram-negative organisms.
  • Cephalosporinase

  • Cephaloglycin

    a cephalorsporin antibiotic.
  • Cephaloridine

    a cephalosporin antibiotic.
  • Cephalosporins

    a group of broad-spectrum antibiotics first isolated from the mediterranean fungus acremonium. they contain the beta-lactam moiety thia-azabicyclo-octenecarboxylic acid also called 7-aminocephalosporanic acid.
  • Cephalothin

    a cephalosporin antibiotic.
  • Cephradine

    a semi-synthetic cephalosporin antibiotic.
  • Clavulanic Acid

    a beta-lactam antibiotic produced by the actinobacterium streptomyces clavuligerus. it is a suicide inhibitor of bacterial beta-lactamase enzymes. administered alone, it has only weak antibacterial activity against most organisms, but given in combination with other beta-lactam antibiotics it prevents antibiotic inactivation by microbial lactamase.
  • Clavulanic Acids

    acids, salts, and derivatives of clavulanic acid (c8h9o5n). they consist of those beta-lactam compounds that differ from penicillin in having the sulfur of the thiazolidine ring replaced by an oxygen. they have limited antibacterial action, but block bacterial beta-lactamase irreversibly, so that similar antibiotics are not broken down by the bacterial enzymes and therefore can exert their antibacterial effects.

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 systemic antibiotics (T36). 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 T36.1X5A to ICD-9-CM

  • ICD-9-CM Code: 995.29 - Adv eff med/biol NEC/NOS
    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: E930.5 - Adv eff cephalosporin
    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 T36.1X5 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
AztreonamT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefacetrileT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefaclorT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefadroxilT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefalexinT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefaloglycinT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefaloridineT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefalosporinsT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefalotinT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefamandoleT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
Cefamycin antibioticT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefapirinT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefatrizineT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefazedoneT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefazolinT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefbuperazoneT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefetametT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefiximeT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefmenoximeT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefmetazoleT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefminoxT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefonicidT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefoperazoneT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CeforanideT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefotaximeT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefotetanT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefotiamT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefoxitinT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefpimizoleT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefpiramideT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefradineT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefroxadineT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefsulodinT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CeftazidimeT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefteramT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CeftezoleT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CeftizoximeT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CeftriaxoneT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefuroximeT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CefuzonamT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CephalexinT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CephaloglycinT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CephaloridineT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CephalosporinsT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
Cephalosporins
  »N (adicillin)
T36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CephalothinT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CephalotinT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
CephradineT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
Clavulanic acidT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
FlomoxefT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6
LatamoxefT36.1X1T36.1X2T36.1X3T36.1X4T36.1X5T36.1X6

Patient Education


Antibiotics

What are antibiotics?

Antibiotics are medicines that fight bacterial infections in people and animals. They work by killing the bacteria or by making it hard for the bacteria to grow and multiply.

Antibiotics can be taken in different ways:

  • Orally (by mouth). This could be pills, capsules, or liquids.
  • Topically. This might be a cream, spray, or ointment that you put on your skin. It could also be eye ointment, eye drops, or ear drops.
  • Through an injection or intravenously (IV). This is usually for more serious infections.

What do antibiotics treat?

Antibiotics only treat certain bacterial infections, such as strep throat, urinary tract infections, and E. coli.

You may not need to take antibiotics for some bacterial infections. For example, you might not need them for many sinus infections or some ear infections. Taking antibiotics when they're not needed won't help you, and they can have side effects. Your health care provider can decide the best treatment for you when you're sick. Don't ask your provider to prescribe an antibiotic for you.

Do antibiotics treat viral infections?

Antibiotics do not work on viral infections. For example, you shouldn't take antibiotics for:

  • Colds and runny noses, even if the mucus is thick, yellow, or green
  • Most sore throats (except strep throat)
  • Flu
  • Most cases of bronchitis

What are the side effects of antibiotics?

The side effects of antibiotics range from minor to very severe. Some of the common side effects include:

  • Rash
  • Nausea
  • Diarrhea
  • Yeast infections

More serious side effects can include:

  • C. diff infections, which cause diarrhea that can lead to severe colon damage and sometimes even death
  • Severe and life-threatening allergic reactions
  • Antibiotic resistance infections

Call your health care provider if you develop any side effects while taking your antibiotic.

Why is it important to take antibiotics only when they're needed?

You should only take antibiotics when they are needed because they can cause side effects and can contribute to antibiotic resistance. Antibiotic resistance happens when the bacteria change and become able to resist the effects of an antibiotic. This means that the bacteria continue to grow.

How do I use antibiotics correctly?

When you take antibiotics, it is important that you take them responsibly:

  • Always follow the directions carefully. Finish your medicine even if you feel better. If you stop taking them too soon, some bacteria may survive and re-infect you.
  • Don't save your antibiotics for later.
  • Don't share your antibiotic with others.
  • Don't take antibiotics prescribed for someone else. This may delay the best treatment for you, make you even sicker, or cause side effects.

Centers for Disease Control and Prevention


[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.