2026 ICD-10-CM Diagnosis Code T38.3X5AAdverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, initial encounter

ICD-10-CM CodesS00–T88T36-T50T38

ICD-10-CM T38.3X5A
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

T38.3X5A is a billable ICD-10-CM diagnosis code for adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, initial encounter. The 7th character A marks it as an initial encounter code, used while the patient is receiving active treatment. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 917 through 918. The code is not accepted as a principal diagnosis by the Medicare Code Editor. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Adverse effects of drugs and medicaments, initial encounter.

Code Identity

ICD-10-CM Code
T38.3X5A
Billable Status
Yes — Valid for Submission
Code Describes
Adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, initial encounter
Short Description
Adverse effect of insulin and oral hypoglycemic drugs, init
Parent Code
Adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs

Code Classification

ChapterS00–T88Injury, poisoning and certain other consequences of external causes
SectionT36-T50Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances
CategoryT38Poisoning by, adverse effect of and underdosing of hormones and their synthetic substitutes and antagonists, not elsewhere classified
This CodeT38.3X5AAdverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, initial encounter

Code EditsBilling

Medicare Code Editor checks that affect claim validity for T38.3X5A.

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.

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Acarbose adverse reaction
  • Acetohexamide adverse reaction
  • Adverse reaction caused by human insulin
  • Adverse reaction following injection of substance
  • Adverse reaction to biguanide hypoglycemic agent
  • Adverse reaction to sulfonyluric hypoglycemic
  • Adverse reaction to zinc insulin
  • Biguanide adverse reaction
  • Chlorpropamide adverse reaction
  • Diabetic drug side effects
  • Drug-induced anaphylaxis
  • Fat hypertrophy
  • Glibenclamide adverse reaction
  • Glibornuride adverse reaction
  • Gliclazide adverse reaction
  • Glipizide adverse reaction
  • Gliquidone adverse reaction
  • Glucagon adverse reaction
  • Glymidine adverse reaction
  • Insulin adverse reaction
  • Insulin lipoatrophy
  • Insulin lipohypertrophy
  • Insulin-induced anaphylaxis
  • Isophane insulin adverse reaction
  • Lipoatrophy caused by injected drug
  • Localized lipoatrophy
  • Metformin adverse reaction
  • Pancytopenia caused by antidiabetic drug
  • Pancytopenia caused by medication
  • Protamine zinc insulin adverse reaction
  • Regular insulin adverse reaction
  • Sulfonylurea adverse reaction
  • Tolazamide adverse reaction
  • Tolbutamide adverse reaction

Coding GuidelinesGuidance

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 applicable episode of care:

  • A - initial encounter
  • D - subsequent encounter
  • S - sequela

Source: ICD-10-CM Official Guidelines for Coding and Reporting, FY 2026, published by CMS and the National Center for Health Statistics.

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR INJ028
Adverse effects of drugs and medicaments, initial encounter
Default principal diagnosis: inpatient No · outpatient Yes

Clinical InformationClinical

  • Acetohexamide

    a sulfonylurea hypoglycemic agent that is metabolized in the liver to 1-hydrohexamide.
  • Buformin

    an oral hypoglycemic agent that inhibits gluconeogenesis, increases glycolysis, and decreases glucose oxidation.
  • Carbutamide

    a sulfonylurea antidiabetic agent with similar actions and uses to chlorpropamide. (from martindale, the extra pharmacopoeia, 30th ed, p277)
  • Chlorpropamide

    a sulfonylurea hypoglycemic agent used in the treatment of non-insulin-dependent diabetes mellitus not responding to dietary modification. (from martindale, the extra pharmacopoeia, 30th ed, p277)
  • Gliclazide

    an oral sulfonylurea hypoglycemic agent which stimulates insulin secretion.
  • Glipizide

    an oral hypoglycemic agent which is rapidly absorbed and completely metabolized.
  • Glucagon

    a 29-amino acid pancreatic peptide derived from proglucagon which is also the precursor of intestinal glucagon-like peptides. glucagon is secreted by pancreatic alpha cells and plays an important role in regulation of blood glucose concentration, ketone metabolism, and several other biochemical and physiological processes. (from gilman et al., goodman and gilman's the pharmacological basis of therapeutics, 9th ed, p1511)
  • Glucagon-Like Peptide 1

    a peptide of 36 or 37 amino acids that is derived from proglucagon and mainly produced by the intestinal l cells. glp-1(1-37 or 1-36) is further n-terminally truncated resulting in glp-1(7-37) or glp-1-(7-36) which can be amidated. these glp-1 peptides are known to enhance glucose-dependent insulin release, suppress glucagon release and gastric emptying, lower blood glucose, and reduce food intake.
  • Glucagon-Like Peptide 2

    a 33-amino acid peptide derived from the c-terminal of proglucagon and mainly produced by the intestinal l cells. it stimulates intestinal mucosal growth and decreased apoptosis of enterocytes. glp-2 enhances gastrointestinal function and plays an important role in nutrient homeostasis.
  • Glucagon-Like Peptide Receptors

    g-protein coupled cell surface receptors that bind glucagon-like peptides and are expressed by cells in pancreatic, intestinal, and neural tissues. these receptors regulate cellular responses to blood glucose, insulin, and inflammation signals.
  • Glucagon-Like Peptide-1 Receptor

    a receptor for glucagon-like peptide 1 (glp-1) expressed primarily on the surface of beta and ductal exocrine cells of the pancreas, as well as cells of other tissues. glp-1 acts through glp-1r to potentiate signaling in pancreatic cells in response to glucose-stimulated insulin secretion (gsis).
  • Glucagon-Like Peptide-1 Receptor Agonists

    compounds that stimulate the activity of glucagon-like peptide-1 receptor. glucagon-like peptide-1 receptor agonists are used to treat type 2 diabetes and obesity.
  • Glucagon-Like Peptide-2 Receptor

    a receptor for glucagon-like peptide 2 (glp-2) that is expressed on the surface of intestinal cells as well as neural cells. glp-2 and other peptides act through glp-2r to regulate cellular responses to blood glucose, inflammation, and food intake.
  • Glucagon-Like Peptides

    peptides derived from proglucagon which is also the precursor of pancreatic glucagon. despite expression of proglucagon in multiple tissues, the major production site of glucagon-like peptides (glps) is the intestinal l cells. glps include glucagon-like peptide 1, glucagon-like peptide 2, and the various truncated forms.
  • Glucagonoma

    an almost always malignant glucagon-secreting tumor derived from the pancreatic alpha cells. it is characterized by a distinctive migratory erythema; weight loss; stomatitis; glossitis; diabetes mellitus; hypoaminoacidemia; and normochromic normocytic anemia.
  • Glucagon-Secreting Cells

    a type of pancreatic cell representing about 5-20% of the islet cells. alpha cells secrete glucagon.
  • Proglucagon

    the common precursor polypeptide of pancreatic glucagon and intestinal glucagon-like peptides. proglucagon is the 158-amino acid segment of preproglucagon without the n-terminal signal sequence. proglucagon is expressed in the pancreas; intestines; and the central nervous system. posttranslational processing of proglucagon is tissue-specific yielding numerous bioactive peptides.
  • Receptors, Glucagon

    cell surface receptors that bind glucagon with high affinity and trigger intracellular changes which influence the behavior of cells. activation of glucagon receptors causes a variety of effects; the best understood is the initiation of a complex enzymatic cascade in the liver which ultimately increases the availability of glucose to body organs.
  • Glyburide

    an antidiabetic sulfonylurea derivative with actions like those of chlorpropamide
  • Metformin

    a biguanide hypoglycemic agent used in the treatment of non-insulin-dependent diabetes mellitus not responding to dietary modification. metformin improves glycemic control by improving insulin sensitivity and decreasing intestinal absorption of glucose. (from martindale, the extra pharmacopoeia, 30th ed, p289)
  • Phenformin

    a biguanide hypoglycemic agent with actions and uses similar to those of metformin. although it is generally considered to be associated with an unacceptably high incidence of lactic acidosis, often fatal, it is still available in some countries. (from martindale, the extra pharmacopoeia, 30th ed, p290)
  • Tolazamide

    a sulphonylurea hypoglycemic agent with actions and uses similar to those of chlorpropamide.

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.

SubstanceAccidentalSelf-harmAssaultUndeter­minedAdverse
Effect
Under­dosing
AcetohexamideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Antidiabetic NECT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Antidiabetic NEC::biguanideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Antidiabetic NEC::biguanide::and sulfonyl combinedT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Antidiabetic NEC::combinedT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Antidiabetic NEC::sulfonylureaT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Biguanide derivatives, oralT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
BuforminT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
CarbutamideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
ChlorpropamideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
DBIT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
DiabineseT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
DymelorT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Extended insulin zinc suspensionT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
GlibenclamideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
GlibornurideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
GliclazideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
GlimidineT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
GlipizideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
GliquidoneT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
GlisolamideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
GlisoxepideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Globin zinc insulinT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
GlucagonT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
GlyburideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
GlyclopyramideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
GlycyclamideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Glymidine sodiumT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
IletinT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Insular tissue extractT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Insulin (amorphous) (globin) (isophane) (Lente) (NPH) (Semilente) (Ultralente)T38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Insulin (amorphous) (globin) (isophane) (Lente) (NPH) (Semilente) (Ultralente)::defalanT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Insulin (amorphous) (globin) (isophane) (Lente) (NPH) (Semilente) (Ultralente)::humanT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Insulin (amorphous) (globin) (isophane) (Lente) (NPH) (Semilente) (Ultralente)::injection, solubleT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Insulin (amorphous) (globin) (isophane) (Lente) (NPH) (Semilente) (Ultralente)::injection, soluble::biphasicT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Insulin (amorphous) (globin) (isophane) (Lente) (NPH) (Semilente) (Ultralente)::intermediate actingT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Insulin (amorphous) (globin) (isophane) (Lente) (NPH) (Semilente) (Ultralente)::protamine zincT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Insulin (amorphous) (globin) (isophane) (Lente) (NPH) (Semilente) (Ultralente)::slow actingT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Insulin (amorphous) (globin) (isophane) (Lente) (NPH) (Semilente) (Ultralente)::zincT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Insulin (amorphous) (globin) (isophane) (Lente) (NPH) (Semilente) (Ultralente)::zinc::protamine injectionT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Insulin (amorphous) (globin) (isophane) (Lente) (NPH) (Semilente) (Ultralente)::zinc::suspension (amorphous) (crystalline)T38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Isophane insulinT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Lente Iletin (insulin)T38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
MetforminT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Neutral insulin injectionT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
NPH Iletin (insulin)T38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
OrinaseT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
PhenforminT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
PhenylethylbiguanideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
PZIT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Sulfonylurea derivatives, oralT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
TolazamideT38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6
Tolbutamide (sodium)T38.3X1T38.3X2T38.3X3T38.3X4T38.3X5T38.3X6

Patient EducationClinical

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.

The full article covers:

  • What is a drug interaction?
  • What are side effects?
  • What are drug allergies?
  • How can I stay safe when taking medicines?

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert T38.3X5A to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
995.23 Adverse eff insulin NOS
ApproximateCombination The match is approximate, and more than one code can be needed to describe the source diagnosis. Confirm with contextual judgment.
ICD-9-CM
E932.3 Adv eff insulin/antidiab
ApproximateCombination The match is approximate, and more than one code can be needed to describe the source diagnosis. Confirm with contextual judgment.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About T38.3X5AOverview

Is T38.3X5A a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, initial encounter on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What does the 7th character A in T38.3X5A mean?

The final character A marks the initial encounter: use it while the patient is receiving active treatment for adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, such as an emergency visit or first evaluation.

What MS-DRG does T38.3X5A group to?

On inpatient claims, adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, initial encounter maps to MS-DRG 917, 918, with relative weights from 0.8571 to 1.5684 depending on complications. Higher weights mean higher Medicare reimbursement.

Can T38.3X5A be a principal diagnosis?

No. The Medicare Code Editor rejects this code as a principal diagnosis because adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, initial encounter describes a circumstance that influences health status rather than a current illness. Report it as a secondary diagnosis.

What is the ICD-9 equivalent of T38.3X5A?

Under the General Equivalence Mappings, adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, initial encounter converts to ICD-9-CM 995.23 (adverse eff insulin NOS) and E932.3 (adv eff insulin/antidiab). The mapping is approximate, so confirm the match fits the documentation.

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.