2024 ICD-10-CM Diagnosis Code T40.2X5S

Adverse effect of other opioids, sequela

ICD-10-CM Code:
T40.2X5S
ICD-10 Code for:
Adverse effect of other opioids, 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 narcotics and psychodysleptics [hallucinogens]
        (T40)

T40.2X5S is a billable diagnosis code used to specify a medical diagnosis of adverse effect of other opioids, 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.

T40.2X5S 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 other opioids. 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:

  • Codeine adverse reaction
  • Diamorphine adverse reaction
  • Dihydrocodeine adverse reaction
  • Drug-induced constipation
  • Morphinan opioid adverse reaction
  • Morphine adverse reaction
  • Opioid analgesic adverse reaction
  • Pruritus caused by drug
  • Pruritus caused by opioid
  • Therapeutic opioid induced constipation

Clinical Classification

Clinical CategoryCCSR Category CodeInpatient Default CCSROutpatient Default CCSR
Mental and substance use disorders; sequelaMBD034X - Not applicable.Y - Yes, default outpatient assignment for principal diagnosis or first-listed diagnosis.
Poisoning/toxic effect/adverse effects/underdosing, sequelaINJ075X - Not applicable.N - Not default outpatient assignment for principal diagnosis or first-listed diagnosis.

Clinical Information

  • Codeine

    an opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. it also acts centrally to suppress cough.
  • Dextrorphan

    dextro form of levorphanol. it acts as a noncompetitive nmda receptor antagonist, among other effects, and has been proposed as a neuroprotective agent. it is also a metabolite of dextromethorphan.
  • Ethylmorphine

    a narcotic analgesic and antitussive. it is metabolized in the liver by ethylmorphine-n-demethylase and used as an indicator of liver function.
  • Ethylmorphine-N-Demethylase

    a drug-metabolizing enzyme of the hepatic microsomal oxidase system which catalyzes the oxidation of the n-methyl group of ethylmorphine with the formation of formaldehyde.
  • Etorphine

    a narcotic analgesic morphinan used as a sedative in veterinary practice.
  • Hydrocodone

    narcotic analgesic related to codeine, but more potent and more addicting by weight. it is used also as cough suppressant.
  • Hydromorphone

    an opioid analgesic made from morphine and used mainly as an analgesic. it has a shorter duration of action than morphine.
  • Glucuronosyltransferase

    a family of enzymes accepting a wide range of substrates, including phenols, alcohols, amines, and fatty acids. they function as drug-metabolizing enzymes that catalyze the conjugation of udpglucuronic acid to a variety of endogenous and exogenous compounds. ec 2.4.1.17.
  • Morphine

    the principal alkaloid in opium and the prototype opiate analgesic and narcotic. morphine has widespread effects in the central nervous system and on smooth muscle.
  • Morphine Dependence

    strong dependence, both physiological and emotional, upon morphine.
  • Morphine Derivatives

    analogs or derivatives of morphine.
  • Receptors, Opioid, mu

    a class of opioid receptors recognized by its pharmacological profile. mu opioid receptors bind, in decreasing order of affinity, endorphins, dynorphins, met-enkephalin, and leu-enkephalin. they have also been shown to be molecular receptors for morphine.
  • Oxycodone

    a semisynthetic derivative of codeine.
  • Oxymorphone

    an opioid analgesic with actions and uses similar to those of morphine, apart from an absence of cough suppressant activity. it is used in the treatment of moderate to severe pain, including pain in obstetrics. it may also be used as an adjunct to anesthesia. (from martindale, the extra pharmacopoeia, 30th ed, p1092)
  • Thebaine

    a drug that is derived from opium, which contains from 0.3-1.5% thebaine depending on its origin. it produces strychnine-like convulsions rather than narcosis. it may be habit-forming and is a controlled substance (opiate) listed in the u.s. code of federal regulations, title 21 part 1308.12 (1985). (from merck index, 11th ed)

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 narcotics and psychodysleptics [hallucinogens] (T40). 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)

T40.2X5S 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 T40.2X5S 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: E935.2 - Adv eff opiates
    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 T40.2X5 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
14-hydroxydihydro-morphinoneT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
AcemorphanT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
AlvodineT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
BenzomorphanT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
CodeineT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
DemerolT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
DesocodeineT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
DextrorphanT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
DifencloxazineT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
DihydrocodeineT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
DihydrocodeinoneT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
DihydrohydroxycodeinoneT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
DihydrohydroxymorphinoneT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
DihydroisocodeineT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
DihydromorphinoneT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
DihydroxycodeinoneT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
DilaudidT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
DioninT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
DrocodeT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
DromoranT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
EthylmorphineT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
EtorphineT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
EucodalT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
HeptalginT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
HycodanT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
HydrocodoneT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
HydromorphinoneT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
HydromorphoneT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
HydroxydihydrocodeinoneT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
LeritineT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
Levo-dromoranT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
MethylmorphineT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
MetoponT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
MorfinT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
MorphineT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
Morphine
  »antagonist
T40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
NisentilT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
NumorphanT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
Opioid NECT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
OxycodoneT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
OxymorphoneT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
ParacodinT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
ParzoneT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
PercodanT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
PiminodineT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
PrinadolT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
RacemorphanT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6
ThebaineT40.2X1T40.2X2T40.2X3T40.2X4T40.2X5T40.2X6

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.