2024 ICD-10-CM Diagnosis Code T40.2X6D
Underdosing of other opioids, subsequent encounter
- ICD-10-CM Code:
- T40.2X6D
- ICD-10 Code for:
- Underdosing of other opioids, subsequent encounter
- Is Billable?
- Yes - Valid for Submission
- Chronic Condition Indicator: [1]
- Not chronic
- Code Navigator:
T40.2X6D is a billable diagnosis code used to specify a medical diagnosis of underdosing of other opioids, subsequent 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. 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.
T40.2X6D is a subsequent encounter code, includes a 7th character and should be used after the patient has completed active treatment for a condition like underdosing of other opioids. According to ICD-10-CM Guidelines a "subsequent encounter" occurs when the patient is receiving routine care for the condition during the healing or recovery phase of treatment. Subsequent diagnosis codes are appropriate during the recovery phase, no matter how many times the patient has seen the provider for this condition. If the provider needs to adjust the patient's care plan due to a setback or other complication, the encounter becomes active again.
Clinical Classification
Clinical Category is Underdosing of drugs and medicaments, subsequent encounter
- CCSR Category Code: INJ066
- Inpatient Default CCSR: X - Not applicable.
- Outpatient Default CCSR: X - Not applicable.
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
Underdosing refers to taking less of a medication than is prescribed by a provider or a manufacturer's instruction. Codes for underdosing should never be assigned as principal or first-listed codes. If a patient has a relapse or exacerbation of the medical condition for which the drug is prescribed because of the reduction in dose, then the medical condition itself should be coded.
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)
T40.2X6D 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 Indicator | Reason for Code | CMS will pay the CC/MCC DRG? |
---|---|---|
Y | Diagnosis was present at time of inpatient admission. | YES |
N | Diagnosis was not present at time of inpatient admission. | NO |
U | Documentation insufficient to determine if the condition was present at the time of inpatient admission. | NO |
W | Clinically undetermined - unable to clinically determine whether the condition was present at the time of inpatient admission. | YES |
1 | Unreported/Not used - Exempt from POA reporting. | NO |
Table of Drugs and Chemicals
The parent code T40.2X6 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.
Patient Education
Medication Errors
Medicines treat infectious diseases, prevent problems from chronic diseases, and ease pain. But medicines can also cause harmful reactions if not used correctly. Errors can happen in the hospital, at the health care provider's office, at the pharmacy, or at home. You can help prevent errors by:
- Knowing your medicines. When you get a prescription, ask the name of the medicine and check to make sure that the pharmacy gave you the right medicine. Make sure that you understand how often you should take the medicine and how long you should take it.
- Keeping a list of medicines.
- Write down all of the medicines that you are taking, including the names of your medicines, how much you take, and when you take them. Make sure to include any over-the-counter medicines, vitamins, supplements, and herbs that you take.
- List the medicines that you are allergic to or that have caused you problems in the past.
- Take this list with you every time you see a health care provider.
- Reading medicine labels and following the directions. Don't just rely on your memory - read the medication label every time. Be especially careful when giving medicines to children.
- Asking questions. If you don't know the answers to these questions, ask your health care provider or pharmacist:
- Why am I taking this medicine?
- What are the common side effects?
- What should I do if I have side effects?
- When should I stop this medicine?
- Can I take this medicine with the other medicines and supplements on my list?
- Do I need to avoid certain foods or alcohol while taking this medicine?
Food and Drug Administration
[Learn More in MedlinePlus]
Pain Relievers
Pain relievers are medicines that reduce or relieve headaches, sore muscles, arthritis, or other aches and pains. There are many different pain medicines, and each one has advantages and risks. Some types of pain respond better to certain medicines than others. Each person may also have a slightly different response to a pain reliever.
Over-the-counter (OTC) medicines are good for many types of pain. There are two main types of OTC pain medicines: acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin, naproxen (Aleve), and ibuprofen (Advil, Motrin) are examples of OTC NSAIDs.
If OTC medicines don't relieve your pain, your doctor may prescribe something stronger. Many NSAIDs are also available at higher prescription doses. The most powerful pain relievers are opioids. They are very effective, but they can sometimes have serious side effects. There is also a risk of addiction. Because of the risks, you must use them only under a doctor's supervision.
There are many things you can do to help ease pain. Pain relievers are just one part of a pain treatment plan.
[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.