2027 ICD-10-CM Diagnosis Code T45.4X6AUnderdosing of iron and its compounds, initial encounter

ICD-10-CM Codes›S00–T88›T36-T50›T45

ICD-10-CM T45.4X6A
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

T45.4X6A is a billable ICD-10-CM diagnosis code for underdosing of iron and its compounds, 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 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 951. The code is not accepted as a principal diagnosis by the Medicare Code Editor. Coders also document this condition as iron taken at lower dose than instructed. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Underdosing of drugs and medicaments, initial encounter.

Code Identity

ICD-10-CM Code
T45.4X6A
Billable Status
Yes — Valid for Submission
Code Describes
Underdosing of iron and its compounds, initial encounter
Short Description
Underdosing of iron and its compounds, initial encounter
Same as the full description in the CMS dataset.
Parent Code
Underdosing of iron and its compounds

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
CategoryT45Poisoning by, adverse effect of and underdosing of primarily systemic and hematological agents, not elsewhere classified
This CodeT45.4X6AUnderdosing of iron and its compounds, initial encounter

Code EditsBilling

Medicare Code Editor checks that affect claim validity for T45.4X6A.

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.

  • Iron taken at lower dose than instructed

Coding GuidelinesGuidance

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 primarily systemic and hematological agents, not elsewhere classified (T45). 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 T45.4X6A: its own notes plus those printed at T45.4X6, T45, 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.

From Block T36-T50 Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances applies to 3,186 codes
  • 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.

From T45.4X6 Underdosing of iron and its compounds applies to 3 codes
From Block T36-T50 Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances applies to 3,186 codes
  • 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.

From Block T36-T50 Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances applies to 3,186 codes
  • abuse and dependence of psychoactive substances (F10-F19)
  • abuse of non-dependence-producing substances (F55.-)
  • immunodeficiency due to drugs (D84.821)
  • drug reaction and poisoning affecting newborn (P00-P96)
  • pathological drug intoxication (inebriation) (F10-F19)
From Chapter 19 (S00-T88) Injury, poisoning and certain other consequences of external causes applies to 41,187 codes

Code First

The underlying condition named in the note is sequenced before this code.

From Block T36-T50 Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances applies to 3,186 codes
  • for adverse effects, the nature of the adverse effect, such as:
  • adverse effect NOS (T88.7)
  • aspirin gastritis (K29.-)
  • blood disorders (D56-D76)
  • contact dermatitis (L23-L25)
  • dermatitis due to substances taken internally (L27.-)
  • nephropathy (N14.0-N14.2)

Use Additional Code

Add a second code, after this one, to fully describe the condition.

From Block T36-T50 Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances applies to 3,186 codes
  • code(s) to specify:
  • manifestations of poisoning
  • underdosing or failure in dosage during medical and surgical care (Y63.6, Y63.8-Y63.9)
  • underdosing of medication regimen (Z91.12-, Z91.13-)
From Chapter 19 (S00-T88) Injury, poisoning and certain other consequences of external causes applies to 41,187 codes
  • code to identify any retained foreign body, if applicable (Z18.-)

Notes

General instructions on how these codes are used.

From Block T36-T50 Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances applies to 3,186 codes
  • The drug giving rise to the adverse effect should be identified by use of codes from categories T36-T50 with fifth or sixth character 5.
From Chapter 19 (S00-T88) Injury, poisoning and certain other consequences of external causes applies to 41,187 codes
  • 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.

From T45 Poisoning by, adverse effect of and underdosing of primarily systemic and hematological agents, not elsewhere classified applies to 270 codes
  • The appropriate 7th character is to be added to each code from category T45
  • Ainitial encounter this code
  • Dsubsequent encounter
  • Ssequela

Source: CMS ICD-10-CM Tabular List. How to read instructional notes.

Referenced in Other NotesGuidance

Instructional notes printed at other codes that name T45.4X6A, its category, or a range that includes it.

Excludes2 2

These codes carry an Excludes2 note naming T45.4X6A: its condition is not part of those codes, and both may be reported when the patient has both.

  • T45.2 Poisoning by, adverse effect of and underdosing of vitamins
    poisoning by, adverse effect of and underdosing of iron (T45.4) names T45.4, which includes this code
  • T45.8 Poisoning by, adverse effect of and underdosing of other primarily systemic and hematological agents
    poisoning by, adverse effect of and underdosing of iron (T45.4) names T45.4, which includes this code

Clinical ClassificationClinical

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

CCSR INJ029
Underdosing of drugs and medicaments, initial encounter
Default principal diagnosis: inpatient No · outpatient No

Clinical InformationClinical

  • Ferritins

    iron-containing proteins that are widely distributed in animals, plants, and microorganisms. their major function is to store iron in a nontoxic bioavailable form. each ferritin molecule consists of ferric iron in a hollow protein shell (apoferritins) made of 24 subunits of various sequences depending on the species and tissue types.

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
Calcium::ferrous citrateT45.4X1T45.4X2T45.4X3T45.4X4T45.4X5T45.4X6
DextriferronT45.4X1T45.4X2T45.4X3T45.4X4T45.4X5T45.4X6
Ferric [See Also: Iron]::chlorideT45.4X1T45.4X2T45.4X3T45.4X4T45.4X5T45.4X6
Ferric [See Also: Iron]::citrateT45.4X1T45.4X2T45.4X3T45.4X4T45.4X5T45.4X6
Ferric [See Also: Iron]::hydroxide::colloidalT45.4X1T45.4X2T45.4X3T45.4X4T45.4X5T45.4X6
Ferric [See Also: Iron]::hydroxide::polymaltoseT45.4X1T45.4X2T45.4X3T45.4X4T45.4X5T45.4X6
Ferric [See Also: Iron]::pyrophosphateT45.4X1T45.4X2T45.4X3T45.4X4T45.4X5T45.4X6
FerritinT45.4X1T45.4X2T45.4X3T45.4X4T45.4X5T45.4X6
FerrocholinateT45.4X1T45.4X2T45.4X3T45.4X4T45.4X5T45.4X6
FerrodextraneT45.4X1T45.4X2T45.4X3T45.4X4T45.4X5T45.4X6
FerropolimalerT45.4X1T45.4X2T45.4X3T45.4X4T45.4X5T45.4X6
Ferrous [See Also: Iron]::phosphateT45.4X1T45.4X2T45.4X3T45.4X4T45.4X5T45.4X6
Ferrous [See Also: Iron]::saltT45.4X1T45.4X2T45.4X3T45.4X4T45.4X5T45.4X6
Ferrous [See Also: Iron]::salt::with folic acidT45.4X1T45.4X2T45.4X3T45.4X4T45.4X5T45.4X6
Ferrous fumerate, gluconate, lactate, salt NEC, sulfate (medicinal)T45.4X1T45.4X2T45.4X3T45.4X4T45.4X5T45.4X6
Iron (compounds) (medicinal) NECT45.4X1T45.4X2T45.4X3T45.4X4T45.4X5T45.4X6
Iron (compounds) (medicinal) NEC::ammoniumT45.4X1T45.4X2T45.4X3T45.4X4T45.4X5T45.4X6
Iron (compounds) (medicinal) NEC::dextran injectionT45.4X1T45.4X2T45.4X3T45.4X4T45.4X5T45.4X6
Iron (compounds) (medicinal) NEC::saltsT45.4X1T45.4X2T45.4X3T45.4X4T45.4X5T45.4X6
Iron (compounds) (medicinal) NEC::sorbitexT45.4X1T45.4X2T45.4X3T45.4X4T45.4X5T45.4X6
Iron (compounds) (medicinal) NEC::sorbitol citric acid complexT45.4X1T45.4X2T45.4X3T45.4X4T45.4X5T45.4X6
Isomaltose, ferric complexT45.4X1T45.4X2T45.4X3T45.4X4T45.4X5T45.4X6
JectoferT45.4X1T45.4X2T45.4X3T45.4X4T45.4X5T45.4X6
PolyferoseT45.4X1T45.4X2T45.4X3T45.4X4T45.4X5T45.4X6
Sodium::iron edetateT45.4X1T45.4X2T45.4X3T45.4X4T45.4X5T45.4X6

Patient EducationClinical

Iron

Iron is a mineral that our bodies need for growth and development. Your body uses iron to make hemoglobin, a protein in red blood cells. Hemoglobin carries oxygen from the lungs to all parts of the body. Iron is also important for healthy muscles, bone marrow, and organ function. Your body also needs iron to make some hormones.

The full article covers:

  • What is iron?
  • How do you get iron?
  • What causes low iron?
  • What happens if you don't get enough iron?
  • What happens if you get too much iron?

Read the full article at MedlinePlus

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

Convert T45.4X6A to ICD-9-CMHistory

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

ICD-9-CM
No Map There is no ICD-9 equivalent for this code.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About T45.4X6AOverview

What is the ICD-10 code for underdosing of iron and its compounds, initial encounter?

The ICD-10-CM code for underdosing of iron and its compounds, initial encounter is T45.4X6A (sometimes written as T454X6A). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

Is T45.4X6A (Underdosing of iron and its compounds) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report underdosing of iron and its compounds, initial encounter on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What does the 7th character A in T45.4X6A mean?

The final character A marks the initial encounter: use it while the patient is receiving active treatment for underdosing of iron and its compounds, such as an emergency visit or first evaluation.

What MS-DRG does T45.4X6A group to?

On inpatient claims, underdosing of iron and its compounds, initial encounter maps to MS-DRG 951 (other Factors Influencing Health Status), which carries a relative weight of 0.5574. Higher weights mean higher Medicare reimbursement.

Can T45.4X6A be a principal diagnosis?

No. The Medicare Code Editor rejects this code as a principal diagnosis because underdosing of iron and its compounds, initial encounter describes a circumstance that influences health status rather than a current illness. Report it as a secondary diagnosis.