2024 ICD-10-CM Diagnosis Code T36.3X5S

Adverse effect of macrolides, sequela

ICD-10-CM Code:
T36.3X5S
ICD-10 Code for:
Adverse effect of macrolides, sequela
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)

T36.3X5S is a billable diagnosis code used to specify a medical diagnosis of adverse effect of macrolides, 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.

T36.3X5S 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 macrolides. 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 oleandomycin
  • Azithromycin adverse reaction
  • Clarithromycin adverse reaction
  • Erythromycin adverse reaction
  • Macrolide adverse reaction
  • Spiramycin adverse reaction

Clinical Classification

Clinical Information

  • Azithromycin

    a semi-synthetic macrolide antibiotic structurally related to erythromycin. it has been used in the treatment of mycobacterium avium intracellulare infections, toxoplasmosis, and cryptosporidiosis.
  • Josamycin

    a macrolide antibiotic from streptomyces narbonensis. the drug has antimicrobial activity against a wide spectrum of pathogens.
  • Kitasamycin

    a macrolide antibiotic produced by streptomyces kitasatoensis. the drug has antimicrobial activity against a wide spectrum of pathogens.
  • Oleandomycin

    antibiotic macrolide produced by streptomyces antibioticus.
  • Pristinamycin

    an antibiotic mixture originally isolated from streptomyces pristinaspiralis. it is a mixture of compounds from streptogramin group a: pristinamycin iia and iib and from streptogramin group b: pristinamycin ia, pristinamycin ib, pristinamycin ic.
  • Streptogramin A

    a specific streptogramin group a antibiotic produced by streptomyces graminofaciens and other bacteria.
  • Streptogramin B

    a specific streptogramin group b antibiotic produced by streptomyces graminofaciens and other bacteria.
  • Roxithromycin

    semisynthetic derivative of erythromycin. it is concentrated by human phagocytes and is bioactive intracellularly. while the drug is active against a wide spectrum of pathogens, it is particularly effective in the treatment of respiratory and genital tract infections.
  • Spiramycin

    a macrolide antibiotic produced by streptomyces ambofaciens. the drug is effective against gram-positive aerobic pathogens, n. gonorrhoeae, and staphylococci. it is used to treat infections caused by bacteria and toxoplasma gondii.
  • Troleandomycin

    a macrolide antibiotic that is similar to erythromycin.

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.

Present on Admission (POA)

T36.3X5S 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 T36.3X5S 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: E930.3 - Adv eff erythromycin
    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 T36.3X5 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
AzithromycinT36.3X1T36.3X2T36.3X3T36.3X4T36.3X5T36.3X6
Erythromycin (salts)T36.3X1T36.3X2T36.3X3T36.3X4T36.3X5T36.3X6
Erythromycin (salts)
  »ophthalmic preparation
T36.3X1T36.3X2T36.3X3T36.3X4T36.3X5T36.3X6
Erythromycin (salts)
  »topical NEC
T36.3X1T36.3X2T36.3X3T36.3X4T36.3X5T36.3X6
IlotycinT36.3X1T36.3X2T36.3X3T36.3X4T36.3X5T36.3X6
Ilotycin
  »ophthalmic preparation
T36.3X1T36.3X2T36.3X3T36.3X4T36.3X5T36.3X6
Ilotycin
  »topical NEC
T36.3X1T36.3X2T36.3X3T36.3X4T36.3X5T36.3X6
JosamycinT36.3X1T36.3X2T36.3X3T36.3X4T36.3X5T36.3X6
KitasamycinT36.3X1T36.3X2T36.3X3T36.3X4T36.3X5T36.3X6
MidecamycinT36.3X1T36.3X2T36.3X3T36.3X4T36.3X5T36.3X6
MiokamycinT36.3X1T36.3X2T36.3X3T36.3X4T36.3X5T36.3X6
OleandomycinT36.3X1T36.3X2T36.3X3T36.3X4T36.3X5T36.3X6
PristinamycinT36.3X1T36.3X2T36.3X3T36.3X4T36.3X5T36.3X6
RokitamycinT36.3X1T36.3X2T36.3X3T36.3X4T36.3X5T36.3X6
RoxithromycinT36.3X1T36.3X2T36.3X3T36.3X4T36.3X5T36.3X6
SpiramycinT36.3X1T36.3X2T36.3X3T36.3X4T36.3X5T36.3X6
TAOT36.3X1T36.3X2T36.3X3T36.3X4T36.3X5T36.3X6
TriacetyloleandomycinT36.3X1T36.3X2T36.3X3T36.3X4T36.3X5T36.3X6
TroleandomycinT36.3X1T36.3X2T36.3X3T36.3X4T36.3X5T36.3X6

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.