2024 ICD-10-CM Diagnosis Code T42.4X5D

Adverse effect of benzodiazepines, subsequent encounter

ICD-10-CM Code:
T42.4X5D
ICD-10 Code for:
Adverse effect of benzodiazepines, subsequent encounter
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 antiepileptic, sedative- hypnotic and antiparkinsonism drugs
        (T42)

T42.4X5D is a billable diagnosis code used to specify a medical diagnosis of adverse effect of benzodiazepines, 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.

T42.4X5D is a subsequent encounter code, includes a 7th character and should be used after the patient has completed active treatment for a condition like adverse effect of benzodiazepines. 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.

Approximate Synonyms

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

  • Adverse reaction to benzodiazepine
  • Adverse reaction to clorazepate
  • Alprazolam adverse reaction
  • Bromazepam adverse reaction
  • Chlordiazepoxide adverse reaction
  • Clobazam adverse reaction
  • Clonazepam adverse reaction
  • Clozapine adverse reaction
  • Diazepam adverse reaction
  • Flunitrazepam adverse reaction
  • Flurazepam adverse reaction
  • Ketazolam adverse reaction
  • Loprazolam adverse reaction
  • Lorazepam adverse reaction
  • Lormetazepam adverse reaction
  • Medazepam adverse reaction
  • Midazolam adverse reaction
  • Nitrazepam adverse reaction
  • Oxazepam adverse reaction
  • Prazepam adverse reaction
  • Temazepam adverse reaction
  • Triazolam adverse reaction

Clinical Classification

Clinical Information

  • Alprazolam

    a triazolobenzodiazepine compound with antianxiety and sedative-hypnotic actions, that is efficacious in the treatment of panic disorders, with or without agoraphobia, and in generalized anxiety disorders. (from ama drug evaluations annual, 1994, p238)
  • Bromazepam

    one of the benzodiazepines that is used in the treatment of anxiety disorders.
  • Chlordiazepoxide

    an anxiolytic benzodiazepine derivative with anticonvulsant, sedative, and amnesic properties. it has also been used in the symptomatic treatment of alcohol withdrawal.
  • Clobazam

    a benzodiazepine derivative that is a long-acting gaba-a receptor agonist. it is used as an antiepileptic in the treatment of seizures, including seizures associated with lennox-gastaut syndrome. it is also used as an anxiolytic, for the short-term treatment of acute anxiety.
  • Clonazepam

    an anticonvulsant used for several types of seizures, including myotonic or atonic seizures, photosensitive epilepsy, and absence seizures, although tolerance may develop. it is seldom effective in generalized tonic-clonic or partial seizures. the mechanism of action appears to involve the enhancement of gamma-aminobutyric acid receptor responses.
  • Clozapine

    a tricylic dibenzodiazepine, classified as an atypical antipsychotic agent. it binds several types of central nervous system receptors, and displays a unique pharmacological profile. clozapine is a serotonin antagonist, with strong binding to 5-ht 2a/2c receptor subtype. it also displays strong affinity to several dopaminergic receptors, but shows only weak antagonism at the dopamine d2 receptor, a receptor commonly thought to modulate neuroleptic activity. agranulocytosis is a major adverse effect associated with administration of this agent.
  • Diazepam

    a benzodiazepine with anticonvulsant, anxiolytic, sedative, muscle relaxant, and amnesic properties and a long duration of action. its actions are mediated by enhancement of gamma-aminobutyric acid activity.
  • Diazepam Binding Inhibitor

    an 86-amino acid polypeptide, found in central and peripheral tissues, that displaces diazepam from the benzodiazepine recognition site on the gamma-aminobutyric acid receptor (receptors, gaba). it also binds medium- and long-chain acyl-coa esters and serves as an acyl-coa transporter. this peptide regulates lipid metabolism.
  • Receptors, GABA-A

    cell surface proteins which bind gamma-aminobutyric acid and contain an integral membrane chloride channel. each receptor is assembled as a pentamer from a pool of at least 19 different possible subunits. the receptors belong to a superfamily that share a common cysteine loop.
  • Estazolam

    a benzodiazepine with anticonvulsant, hypnotic, and muscle relaxant properties. it has been shown in some cases to be more potent than diazepam or nitrazepam.
  • Flunitrazepam

    a benzodiazepine with pharmacologic actions similar to those of diazepam that can cause anterograde amnesia. some reports indicate that it is used as a date rape drug and suggest that it may precipitate violent behavior. the united states government has banned the importation of this drug.
  • Flurazepam

    a benzodiazepine derivative used mainly as a hypnotic.
  • Lorazepam

    a benzodiazepine used as an anti-anxiety agent with few side effects. it also has hypnotic, anticonvulsant, and considerable sedative properties and has been proposed as a preanesthetic agent.
  • Medazepam

    a benzodiazepine derivative used in the treatment of anxiety. it has sedative, muscle relaxant, and anticonvulsant properties. one of its metabolites is diazepam and one of its excretion products is oxazepam.
  • Midazolam

    a short-acting hypnotic-sedative drug with anxiolytic and amnestic properties. it is used in dentistry, cardiac surgery, endoscopic procedures, as preanesthetic medication, and as an adjunct to local anesthesia. the short duration and cardiorespiratory stability makes it useful in poor-risk, elderly, and cardiac patients. it is water-soluble at ph less than 4 and lipid-soluble at physiological ph.
  • Nitrazepam

    a benzodiazepine derivative used as an anticonvulsant and hypnotic.
  • Nordazepam

    an intermediate in the metabolism of diazepam to oxazepam. it may have actions similar to those of diazepam.
  • Oxazepam

    a benzodiazepine used in the treatment of anxiety, alcohol withdrawal, and insomnia.
  • Prazepam

    a benzodiazepine that is used in the treatment of anxiety disorders.
  • Temazepam

    a benzodiazepine that acts as a gamma-aminobutyric acid modulator and anti-anxiety agent.
  • Triazolam

    a short-acting benzodiazepine used in the treatment of insomnia. some countries temporarily withdrew triazolam from the market because of concerns about adverse reactions, mostly psychological, associated with higher dose ranges. its use at lower doses with appropriate care and labeling has been reaffirmed by the fda and most other countries.

Coding Guidelines

When coding an adverse effect of a drug that has been correctly prescribed and properly administered, assign the appropriate code for the nature of the adverse effect followed by the appropriate code for the adverse effect of the drug.

The appropriate 7th character is to be added to each code from block Poisoning by, adverse effect of and underdosing of antiepileptic, sedative- hypnotic and antiparkinsonism drugs (T42). 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)

T42.4X5D 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 T42.4X5D to ICD-9-CM

  • ICD-9-CM Code: V58.89 - Other specfied aftercare
    Approximate Flag - The approximate mapping means there is not an exact match between the ICD-10 and ICD-9 codes and the mapped code is not a precise representation of the original code.

Table of Drugs and Chemicals

The parent code T42.4X5 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
AlprazolamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
BentazepamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
BenzodiapinT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
Benzodiazepine NECT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
BromazepamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
BrotizolamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
CamazepamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
CarpipramineT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
ChlordiazepoxideT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
ClobazamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
ClonazepamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
Clorazepate (dipotassium)T42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
ClotiazepamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
CloxazolamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
ClozapineT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
DalmaneT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
DelorazepamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
DiazepamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
EstazolamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
EtizolamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
FludiazepamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
FlunitrazepamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
FlurazepamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
FlutazolamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
FlutoprazepamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
HalazepamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
HaloxazolamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
KetazolamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
LibriumT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
LoprazolamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
LorazepamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
LormetazepamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
MedazepamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
MexazolamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
MidazolamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
NimetazepamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
NitrazepamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
NordazepamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
OxazepamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
OxazolamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
PerlapineT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
PinazepamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
PrazepamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
QuazepamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
RohypnolT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
SeraxT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
TemazepamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
TetrazepamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
TofisopamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
TranxeneT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
TriazolamT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6
ValiumT42.4X1T42.4X2T42.4X3T42.4X4T42.4X5T42.4X6

Patient Education


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, such as drug interactions, side effects, and allergies.

What is a drug interaction?

A drug interaction is a change in the way a drug acts in the body when taken with certain other drugs, foods, or supplements or when taken while you have certain medical conditions. Examples include:

  • Two drugs, such as aspirin and blood thinners
  • Drugs and food, such as statins and grapefruit
  • Drugs and supplements, such as gingko and blood thinners
  • Drugs and medical conditions, such as aspirin and peptic ulcers

Interactions could cause a drug to be more or less effective, cause side effects, or change the way one or both drugs work.

What are side effects?

Side effects are unwanted, usually unpleasant, effects caused by medicines. Most are mild, such as a stomachache, dry mouth, or drowsiness, and go away after you stop taking the medicine. Others can be more serious. Sometimes a drug can interact with a disease that you have and cause a side effect. For example, if you have a heart condition, certain decongestants can cause you to have a rapid heartbeat.

What are drug allergies?

Drug allergies are another type of reaction. They can range from mild to life-threatening. Skin reactions, such as hives and rashes, are the most common type. Anaphylaxis, a serious allergic reaction, is less common.

How can I stay safe when taking medicines?

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


[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.