2024 ICD-10-CM Diagnosis Code T40.496A

Clinical Information

• Alphaprodine

  an opioid analgesic chemically related to and with an action resembling that of meperidine, but more rapid in onset and of shorter duration. it has been used in obstetrics, as pre-operative medication, for minor surgical procedures, and for dental procedures. (from martindale, the extra pharmacopoeia, 30th ed, p1067)

• Buprenorphine

  a derivative of the opioid alkaloid thebaine that is a more potent and longer lasting analgesic than morphine. it appears to act as a partial agonist at mu and kappa opioid receptors and as an antagonist at delta receptors. the lack of delta-agonist activity has been suggested to account for the observation that buprenorphine tolerance may not develop with chronic use.

• Buprenorphine, Naloxone Drug Combination

  a pharmaceutical preparation that combines buprenorphine, an opioid analgesics with naloxone, a narcotic antagonists to reduce the potential for narcotic dependence in the treatment of pain. it may also be used for opioid substitution therapy.

• Butorphanol

  a synthetic morphinan analgesic with narcotic antagonist action. it is used in the management of severe pain.

• Dextropropoxyphene

  a narcotic analgesic structurally related to methadone. only the dextro-isomer has an analgesic effect; the levo-isomer appears to exert an antitussive effect.

• Levopropoxyphene

  a propionate derivative that is used to suppress coughing.

• Levorphanol

  a narcotic analgesic that may be habit-forming. it is nearly as effective orally as by injection.

• Meperidine

  a narcotic analgesic that can be used for the relief of most types of moderate to severe pain, including postoperative pain and the pain of labor. prolonged use may lead to dependence of the morphine type; withdrawal symptoms appear more rapidly than with morphine and are of shorter duration.

• Nalbuphine

  a narcotic used as a pain medication. it appears to be an agonist at kappa receptors and an antagonist or partial agonist at mu receptors.

• Pentazocine

  the first mixed agonist-antagonist analgesic to be marketed. it is an agonist at the kappa and sigma opioid receptors and has a weak antagonist action at the mu receptor. (from ama drug evaluations annual, 1991, p97)

• Phenazocine

  an opioid analgesic with actions and uses similar to morphine. (from martindale, the extra pharmacopoeia, 30th ed, p1095)

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.

Replacement Code

T40496A replaces the following previously assigned ICD-10-CM code(s):

• T40.4X6A - Underdosing of other synthetic narcotics, initial encounter

Table of Drugs and Chemicals

The parent code T40.496 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.

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 - Code Added, effective from 10/1/2020 through 9/30/2021