2027 ICD-10-CM Diagnosis Code T36.1X2SPoisoning by cephalosporins and other beta-lactam antibiotics, intentional self-harm, sequela
T36.1X2S is a billable ICD-10-CM diagnosis code for poisoning by cephalosporins and other beta-lactam antibiotics, intentional self-harm, sequela. The 7th character S marks it as a sequela code, which reports a problem that remains after the original condition has resolved. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 922 through 923. The code is exempt from POA reporting. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Mental and substance use disorders; sequela; and Poisoning/toxic effect/adverse effects/underdosing, sequela.
T36.1X2S no longer risk-adjusts for Medicare Advantage: it mapped to HCC 59 under the retired CMS-HCC V24 model through payment year 2025 but maps to no category in the live V28 model. It still risk-adjusts in the PACE (CMS-HCC V22) category 58, ESRD (V21) category 58, and ESRD (V24) category 59 for payment year 2027.
Code Identity
Code Classification
Present on Admission (POA)Billing
T36.1X2S is exempt from POA reporting on inpatient claims to general acute care hospitals. Review the other POA exempt codes in Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances (T36-T50).
Medicare Risk Adjustment (HCC)Billing
T36.1X2S no longer risk-adjusts for Medicare Advantage: it maps to no payment category in the live CMS-HCC V28 model, although it still risk-adjusts in the other CMS models shown below.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Cefaclor overdose
- Cefaclor poisoning
- Cefadroxil overdose
- Cefadroxil poisoning
- Cefixime overdose
- Cefixime poisoning
- Cefodizime overdose
- Cefodizime poisoning
- Cefotaxime overdose
- Cefotaxime poisoning
- Cefpirome overdose
- Cefpirome poisoning
- Cefpodoxime overdose
- Cefpodoxime poisoning
- Cefsulodin overdose
- Cefsulodin poisoning
- Ceftazidime overdose
- Ceftazidime poisoning
- Ceftibuten overdose
- Ceftibuten poisoning
- Ceftizoxime overdose
- Ceftizoxime poisoning
- Ceftriaxone overdose
- Ceftriaxone poisoning
- Cefuroxime overdose
- Cefuroxime poisoning
- Cephalexin overdose
- Cephalothin overdose
- Cephamandole overdose
- Cephamandole poisoning
- Cephazolin overdose
- Cephazolin poisoning
- Cephradine overdose
- Cephradine poisoning
- Fourth generation cephalosporin overdose
- Fourth generation cephalosporin poisoning
- Intentional cefaclor overdose
- Intentional cefaclor poisoning
- Intentional cefadroxil overdose
- Intentional cefadroxil poisoning
- Intentional cefixime overdose
- Intentional cefixime poisoning
- Intentional cefodizime overdose
- Intentional cefodizime poisoning
- Intentional cefotaxime overdose
- Intentional cefotaxime poisoning
- Intentional cefpirome overdose
- Intentional cefpirome poisoning
- Intentional cefpodoxime overdose
- Intentional cefpodoxime poisoning
- Intentional cefsulodin overdose
- Intentional cefsulodin poisoning
- Intentional ceftazidime overdose
- Intentional ceftazidime poisoning
- Intentional ceftibuten overdose
- Intentional ceftibuten poisoning
- Intentional ceftizoxime overdose
- Intentional ceftizoxime poisoning
- Intentional ceftriaxone overdose
- Intentional ceftriaxone poisoning
- Intentional cefuroxime overdose
- Intentional cefuroxime poisoning
- Intentional cephalexin overdose
- Intentional cephalexin poisoning
- Intentional cephaloridine poisoning
- Intentional cephalothin overdose
- Intentional cephalothin poisoning
- Intentional cephamandole overdose
- Intentional cephamandole poisoning
- Intentional cephazolin overdose
- Intentional cephazolin poisoning
- Intentional cephradine overdose
- Intentional cephradine poisoning
- Intentional latamoxef overdose
- Intentional latamoxef poisoning
- Latamoxef overdose
- Latamoxef poisoning
- Poisoning by cephalexin
- Poisoning by cephaloridine
- Poisoning by cephalothin
- Second generation cephalosporin overdose
Coding GuidelinesGuidance
When coding a poisoning or reaction to the improper use of a medication (e.g., overdose, wrong substance given or taken in error, wrong route of administration), first assign the appropriate code from categories T36-T50. The poisoning codes have an associated intent as their 5th or 6th character (accidental, intentional self-harm, assault and undetermined). If the intent of the poisoning is unknown or unspecified, code the intent as accidental intent. The undetermined intent is only for use if the documentation in the record specifies that the intent cannot be determined. Use additional code(s) for all manifestations of poisonings.
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 applicable episode of care:
- A - initial encounter
- D - subsequent encounter
- S - sequela
Source: ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027, published by CMS and the National Center for Health Statistics.
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to T36.1X2S: its own notes plus those printed at T36, block T36-T50, and Chapter 19. A note printed at a category, block or chapter applies to every code under it.
Includes
Further defines, or gives examples of, the content of the category.
- adverse effect of correct substance properly administered
- poisoning by overdose of substance
- poisoning by wrong substance given or taken in error
- underdosing by (inadvertently) (deliberately) taking less substance than prescribed or instructed
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
- toxic reaction to local anesthesia in pregnancy (O29.3-)
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
Code First
The underlying condition named in the note is sequenced before this code.
Use Additional Code
Add a second code, after this one, to fully describe the condition.
- code to identify any retained foreign body, if applicable (Z18.-)
Notes
General instructions on how these codes are used.
- Use secondary code(s) from Chapter 20, External causes of morbidity, to indicate cause of injury. Codes within the T section that include the external cause do not require an additional external cause code
- The chapter uses the S-section for coding different types of injuries related to single body regions and the T-section to cover injuries to unspecified body regions as well as poisoning and certain other consequences of external causes.
7th Character
Every code in the category takes a 7th character from the listed values, with the placeholder X filling any empty positions before it.
- The appropriate 7th character is to be added to each code from category T36
- Ainitial encounter
- Dsubsequent encounter
- Ssequela this code
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Table of Drugs and ChemicalsClinical
Substances in the Table of Drugs and Chemicals that reference this code family. Always confirm in the Tabular List before coding.
Patient EducationClinical
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.
The full article covers:
- What are antibiotics?
- What do antibiotics treat?
- Do antibiotics treat viral infections?
- What are the side effects of antibiotics?
- Why is it important to take antibiotics only when they're needed?
- How do I use antibiotics correctly?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert T36.1X2S to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About T36.1X2SOverview
Is T36.1X2S a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report poisoning by cephalosporins and other beta-lactam antibiotics, intentional self-harm, sequela on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What does the 7th character S in T36.1X2S mean?
The final character S makes this a sequela code: it reports a lingering problem that remains after the poisoning by cephalosporins and other beta-lactam antibiotics, intentional self-harm itself has resolved, not the original event.
What MS-DRG does T36.1X2S group to?
When poisoning by cephalosporins and other beta-lactam antibiotics, intentional self-harm, sequela is the principal diagnosis on an inpatient stay, it groups to MS-DRG 923, 922, with relative weights from 0.9980 to 1.6248 depending on complications. Higher weights mean higher Medicare reimbursement.
Is T36.1X2S exempt from POA reporting?
Yes. CMS lists this code among those exempt from present on admission reporting, so hospitals do not assign a POA indicator for poisoning by cephalosporins and other beta-lactam antibiotics, intentional self-harm, sequela on inpatient claims. The code appears in the Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances (T36-T50) range of the CMS exempt list.
Can T36.1X2S be reported with a code from T45.1?
Not as a rule. The Excludes1 note at T36, which applies to T36.1X2S, lists "antineoplastic antibiotics (T45.1-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
Does T36.1X2S risk-adjust for Medicare Advantage payment?
Not for Medicare Advantage. T36.1X2S mapped to HCC 59 in the retired CMS-HCC V24 model, which last determined payment in 2025, but it maps to no category in the live V28 model; see all codes that no longer risk-adjust. It still risk-adjusts in the PACE (CMS-HCC V22) category 58 (Major Depressive/Bipolar/and Paranoid Disorders), ESRD (V21) category 58 (Major Depressive/Bipolar/and Paranoid Disorders), and ESRD (V24) category 59 (Major Depressive/Bipolar/and Paranoid Disorders).
