2024 ICD-10-CM Diagnosis Code T46.4X1S

Poisoning by angiotensin-converting-enzyme inhibitors, accidental (unintentional), sequela

ICD-10-CM Code:
T46.4X1S
ICD-10 Code for:
Poisoning by angiotens-convert-enzyme inhibtr, acc, 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 agents primarily affecting the cardiovascular system
        (T46)

T46.4X1S is a billable diagnosis code used to specify a medical diagnosis of poisoning by angiotensin-converting-enzyme inhibitors, accidental (unintentional), 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.

T46.4X1S is a sequela code, includes a 7th character and should be used for complications that arise as a direct result of a condition like poisoning by angiotensin-converting-enzyme inhibitors accidental (unintentional). 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:

  • Accidental overdose by angiotensin-converting enzyme inhibitor
  • Accidental poisoning by angiotensin-converting enzyme inhibitor
  • Overdose of angiotensin-converting-enzyme inhibitors
  • Poisoning by angiotensin-converting-enzyme inhibitors

Clinical Classification

Clinical Information

  • Captopril

    a potent and specific inhibitor of peptidyl-dipeptidase a. it blocks the conversion of angiotensin i to angiotensin ii, a vasoconstrictor and important regulator of arterial blood pressure. captopril acts to suppress the renin-angiotensin system and inhibits pressure responses to exogenous angiotensin.
  • Cilazapril

    one of the angiotensin-converting enzyme inhibitors (ace inhibitors) used for hypertension. it is a prodrug that is hydrolyzed after absorption to its main metabolite cilazaprilat.
  • Enalapril

    an angiotensin-converting enzyme inhibitor that is used to treat hypertension and heart failure.
  • Enalaprilat

    the active metabolite of enalapril and one of the potent, intravenously administered, angiotensin-converting enzyme inhibitors. it is an effective agent for the treatment of essential hypertension and has beneficial hemodynamic effects in heart failure. the drug produces renal vasodilation with an increase in sodium excretion.
  • Fosinopril

    a phosphinic acid-containing angiotensin-converting enzyme inhibitor that is effective in the treatment of hypertension. it is a prodrug that is converted to its active metabolite fosinoprilat.
  • Lisinopril

    one of the angiotensin-converting enzyme inhibitors (ace inhibitors), orally active, that has been used in the treatment of hypertension and congestive heart failure.
  • Perindopril

    an angiotensin-converting enzyme inhibitor. it is used in patients with hypertension and heart failure.
  • Quinapril

    a tetrahydroisoquinoline derivative and angiotensin converting enzyme inhibitor that is used in the treatment of hypertension and heart failure.
  • Ramipril

    a long-acting angiotensin-converting enzyme inhibitor. it is a prodrug that is transformed in the liver to its active metabolite ramiprilat.

Coding Guidelines

When coding a poisoning or reaction to the improper use of a medication (e.g., overdose, wrong substance given or taken in error, wrong route of administration), first assign the appropriate code from categories T36-T50. The poisoning codes have an associated intent as their 5th or 6th character (accidental, intentional self-harm, assault and undetermined. If the intent of the poisoning is unknown or unspecified, code the intent as accidental intent. The undetermined intent is only for use if the documentation in the record specifies that the intent cannot be determined. Use additional code(s) for all manifestations of poisonings.

The appropriate 7th character is to be added to each code from block Poisoning by, adverse effect of and underdosing of agents primarily affecting the cardiovascular system (T46). Use the following options for the aplicable episode of care:

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

Present on Admission (POA)

T46.4X1S 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 T46.4X1S to ICD-9-CM

  • ICD-9-CM Code: 909.0 - Late eff drug poisoning
    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: E929.2 - Late eff acc poisoning
    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 T46.4X1 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
AlaceprilT46.4X1T46.4X2T46.4X3T46.4X4T46.4X5T46.4X6
BenazeprilT46.4X1T46.4X2T46.4X3T46.4X4T46.4X5T46.4X6
CaptoprilT46.4X1T46.4X2T46.4X3T46.4X4T46.4X5T46.4X6
CilazaprilT46.4X1T46.4X2T46.4X3T46.4X4T46.4X5T46.4X6
EnalaprilT46.4X1T46.4X2T46.4X3T46.4X4T46.4X5T46.4X6
EnalaprilatT46.4X1T46.4X2T46.4X3T46.4X4T46.4X5T46.4X6
FosinoprilT46.4X1T46.4X2T46.4X3T46.4X4T46.4X5T46.4X6
Fosinopril
  »sodium
T46.4X1T46.4X2T46.4X3T46.4X4T46.4X5T46.4X6
InhibitorT46.4X1T46.4X2T46.4X3T46.4X4T46.4X5T46.4X6
Inhibitor
  »angiotensin-converting enzyme
T46.4X1T46.4X2T46.4X3T46.4X4T46.4X5T46.4X6
Inhibitor
  »carbonic anhydrase
T46.4X1T46.4X2T46.4X3T46.4X4T46.4X5T46.4X6
Inhibitor
  »fibrinolysis
T46.4X1T46.4X2T46.4X3T46.4X4T46.4X5T46.4X6
Inhibitor
  »monoamine oxidase NEC
T46.4X1T46.4X2T46.4X3T46.4X4T46.4X5T46.4X6
Inhibitor
  »monoamine oxidase NEC
    »hydrazine
T46.4X1T46.4X2T46.4X3T46.4X4T46.4X5T46.4X6
Inhibitor
  »postsynaptic
T46.4X1T46.4X2T46.4X3T46.4X4T46.4X5T46.4X6
Inhibitor
  »prothrombin synthesis
T46.4X1T46.4X2T46.4X3T46.4X4T46.4X5T46.4X6
LisinoprilT46.4X1T46.4X2T46.4X3T46.4X4T46.4X5T46.4X6
PerindoprilT46.4X1T46.4X2T46.4X3T46.4X4T46.4X5T46.4X6
QuinaprilT46.4X1T46.4X2T46.4X3T46.4X4T46.4X5T46.4X6
RamiprilT46.4X1T46.4X2T46.4X3T46.4X4T46.4X5T46.4X6
SpiraprilT46.4X1T46.4X2T46.4X3T46.4X4T46.4X5T46.4X6
ZofenoprilT46.4X1T46.4X2T46.4X3T46.4X4T46.4X5T46.4X6

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]

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.