ICD-10-CM Code T46.4X5S

Adverse effect of angiotensin-converting-enzyme inhibitors, sequela

Version 2020 Replaced Code Billable Code Unacceptable Principal Diagnosis POA Exempt

Valid for Submission

T46.4X5S is a billable code used to specify a medical diagnosis of adverse effect of angiotensin-converting-enzyme inhibitors, sequela. The code is valid for the year 2020 for the submission of HIPAA-covered transactions. The ICD-10-CM code T46.4X5S might also be used to specify conditions or terms like ace inhibitor-aggravated angioedema, acute drug-induced renal failure, acute renal failure due to ace inhibitor, adverse reaction caused by losartan, angioedema due to angiotensin-converting-enzyme inhibitor, angiotensin ii receptor antagonist adverse reaction, etc The code is exempt from present on admission (POA) reporting for inpatient admissions to general acute care hospitals.

The code T46.4X5S 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.

Short Description:Adverse effect of angiotens-convert-enzyme inhibtr, sequela
Long Description:Adverse effect of angiotensin-converting-enzyme inhibitors, sequela

Replaced Code

This code was replaced in the 2020 ICD-10 code set with the code(s) listed below. The National Center for Health Statistics (NCHS) has published an update to the ICD-10-CM diagnosis codes which became effective October 1, 2019. This code was replaced for the FY 2020 (October 1, 2019 - September 30, 2020).

  • K59.03 - Drug induced constipation

Code Edits

The Medicare Code Editor (MCE) detects and reports errors in the coding of claims data. The following ICD-10 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.


The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

  • ACE inhibitor-aggravated angioedema
  • Acute drug-induced renal failure
  • Acute renal failure due to ACE inhibitor
  • Adverse reaction caused by losartan
  • Angioedema due to angiotensin-converting-enzyme inhibitor
  • Angiotensin II receptor antagonist adverse reaction
  • Angiotensin-converting-enzyme inhibitor adverse reaction
  • Captopril adverse reaction
  • Cilazapril adverse reaction
  • Drug-aggravated angioedema-urticaria
  • Drug-induced hyperkalemia
  • Enalapril adverse reaction
  • Fetal captopril/enalapril syndrome
  • Fetal or neonatal effect of maternal use of antihypertensive drug
  • Fosinopril adverse reaction
  • Hyperkalemia due to angiotensin-converting enzyme inhibitor
  • Intestinal angioedema caused by angiotensin-converting enzyme inhibitor
  • Lisinopril adverse reaction
  • Nephrotoxic acute renal failure
  • Non-allergic drug hypersensitivity disorder
  • Non-allergic hypersensitivity to angiotensin II receptor antagonist
  • Non-allergic hypersensitivity to angiotensin-converting enzyme inhibitor
  • Non-allergic hypersensitivity to benazepril
  • Non-allergic hypersensitivity to captopril
  • Non-allergic hypersensitivity to cilazapril
  • Non-allergic hypersensitivity to enalapril
  • Non-allergic hypersensitivity to fosinopril
  • Non-allergic hypersensitivity to imidapril
  • Non-allergic hypersensitivity to lisinopril
  • Non-allergic hypersensitivity to losartan
  • Non-allergic hypersensitivity to moexipril
  • Non-allergic hypersensitivity to perindopril
  • Non-allergic hypersensitivity to quinapril
  • Non-allergic hypersensitivity to ramipril
  • Non-allergic hypersensitivity to trandolapril
  • Perindopril adverse reaction
  • Quinapril adverse reaction
  • Ramipril adverse reaction
  • Trandolapril adverse reaction

Diagnostic Related Groups

The ICD-10 code T46.4X5S is grouped in the following groups for version MS-DRG V37.0 What are Diagnostic Related Groups?
The Diagnostic Related Groups (DRGs) are a patient classification scheme which provides a means of relating the type of patients a hospital treats. The DRGs divides all possible principal diagnoses into mutually exclusive principal diagnosis areas referred to as Major Diagnostic Categories (MDC).
applicable from 10/01/2019 through 09/30/2020.


Present on Admission (POA)

T46.4X5S 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 CodePOA Reason 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 T46.4X5S to ICD-9

  • 909.5 - Lte efct advrs efct drug (Combination Flag)
  • E942.6 - Adv eff antihyperten agt (Combination Flag)

Code Classification

  • Injury, poisoning and certain other consequences of external causes (S00–T98)
    • Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances (T36-T50)
      • Agents primarily affecting the cardiovascular system (T46)

Code History

  • FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016
    (First year ICD-10-CM implemented into the HIPAA code set)
  • FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
  • FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
  • FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
  • FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020

Information for Patients

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.

One problem is interactions, which may occur between

  • Two drugs, such as aspirin and blood thinners
  • Drugs and food, such as statins and grapefruit
  • Drugs and supplements, such as ginkgo and blood thinners
  • Drugs and diseases, such as aspirin and peptic ulcers

Interactions can change the actions of one or both drugs. The drugs might not work, or you could get side effects.

Side effects are unwanted effects caused by the drugs. Most are mild, such as a stomach aches or drowsiness, and go away after you stop taking the drug. Others can be more serious.

Drug allergies are another type of reaction. They can be mild or life-threatening. Skin reactions, such as hives and rashes, are the most common type. Anaphylaxis, a serious allergic reaction, is more rare.

When you start a new prescription or over-the-counter medication, make sure you understand how to take it correctly. Know which other medications and foods you need to avoid. Ask your health care provider or pharmacist if you have questions.

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