2024 ICD-10-CM Diagnosis Code T36.95XA

Adverse effect of unspecified systemic antibiotic, initial encounter

ICD-10-CM Code:
T36.95XA
ICD-10 Code for:
Adverse effect of unsp systemic antibiotic, init encntr
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)

T36.95XA is a billable diagnosis code used to specify a medical diagnosis of adverse effect of unspecified systemic antibiotic, 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.

T36.95XA 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 unspecified systemic antibiotic. 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.

Unspecified diagnosis codes like T36.95XA are acceptable when clinical information is unknown or not available about a particular condition. Although a more specific code is preferable, unspecified codes should be used when such codes most accurately reflect what is known about a patient's condition. Specific diagnosis codes should not be used if not supported by the patient's medical record.

Approximate Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

  • Allergic reaction caused by antibacterial agent
  • Allergic reaction caused by antibacterial agent
  • Anaphylaxis caused by antibacterial agent
  • Antibacterial drug adverse reaction
  • Antibiotic enterocolitis
  • Antibiotic-associated diarrhea
  • Antibiotic-induced neuromuscular blocking
  • Drug-induced anaphylaxis
  • Drug-induced colitis
  • Drug-induced enteritis of intestine
  • Drug-induced myasthenia
  • Jarisch Herxheimer reaction
  • Noninfective enteritis and colitis
  • Suppression of microbiota of gastrointestinal tract caused by antibiotic
  • Toxic enteritis of small intestine caused by drug
  • Toxic neuromuscular junction disorder

Clinical Classification

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 T36.95XA 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: E930.8 - Adv eff antibiotics NEC
    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 T36.95 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
Antibiotic NECT36.91T36.92T36.93T36.94T36.95T36.96
Antibiotic NEC
  »aminoglycoside
T36.91T36.92T36.93T36.94T36.95T36.96
Antibiotic NEC
  »anticancer
T36.91T36.92T36.93T36.94T36.95T36.96
Antibiotic NEC
  »antifungal
T36.91T36.92T36.93T36.94T36.95T36.96
Antibiotic NEC
  »antimycobacterial
T36.91T36.92T36.93T36.94T36.95T36.96
Antibiotic NEC
  »antineoplastic
T36.91T36.92T36.93T36.94T36.95T36.96
Antibiotic NEC
  »cephalosporin (group)
T36.91T36.92T36.93T36.94T36.95T36.96
Antibiotic NEC
  »chloramphenicol (group)
T36.91T36.92T36.93T36.94T36.95T36.96
Antibiotic NEC
  »ENT
T36.91T36.92T36.93T36.94T36.95T36.96
Antibiotic NEC
  »eye
T36.91T36.92T36.93T36.94T36.95T36.96
Antibiotic NEC
  »fungicidal (local)
T36.91T36.92T36.93T36.94T36.95T36.96
Antibiotic NEC
  »intestinal
T36.91T36.92T36.93T36.94T36.95T36.96
Antibiotic NEC
  »b-lactam NEC
T36.91T36.92T36.93T36.94T36.95T36.96
Antibiotic NEC
  »local
T36.91T36.92T36.93T36.94T36.95T36.96
Antibiotic NEC
  »macrolides
T36.91T36.92T36.93T36.94T36.95T36.96
Antibiotic NEC
  »polypeptide
T36.91T36.92T36.93T36.94T36.95T36.96
Antibiotic NEC
  »specified NEC
T36.91T36.92T36.93T36.94T36.95T36.96
Antibiotic NEC
  »tetracycline (group)
T36.91T36.92T36.93T36.94T36.95T36.96
Antibiotic NEC
  »throat
T36.91T36.92T36.93T36.94T36.95T36.96

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.