2024 ICD-10-CM Diagnosis Code T43.596D

Underdosing of other antipsychotics and neuroleptics, subsequent encounter

ICD-10-CM Code:
T43.596D
ICD-10 Code for:
Underdosing of oth antipsychotics and neuroleptics, subs
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 psychotropic drugs, not elsewhere classified
        (T43)

T43.596D is a billable diagnosis code used to specify a medical diagnosis of underdosing of other antipsychotics and neuroleptics, 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.

T43.596D is a subsequent encounter code, includes a 7th character and should be used after the patient has completed active treatment for a condition like underdosing of other antipsychotics and neuroleptics. 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.

Clinical Classification

Clinical Information

  • Amisulpride

    a benzamide derivative that is used as an antipsychotic agent for the treatment of schizophrenia. it is also used as an antidepressive agent.
  • Buspirone

    an anxiolytic agent and serotonin receptor agonist belonging to the azaspirodecanedione class of compounds. its structure is unrelated to those of the benzodiazapines, but it has an efficacy comparable to diazepam.
  • Droperidol

    a butyrophenone with general properties similar to those of haloperidol. it is used in conjunction with an opioid analgesic such as fentanyl to maintain the patient in a calm state of neuroleptanalgesia with indifference to surroundings but still able to cooperate with the surgeon. it is also used as a premedicant, as an antiemetic, and for the control of agitation in acute psychoses. (from martindale, the extra pharmacopoeia, 29th ed, p593)
  • Fluspirilene

    a long-acting injectable antipsychotic agent used for chronic schizophrenia.
  • Hydroxyzine

    a histamine h1 receptor antagonist that is effective in the treatment of chronic urticaria, dermatitis, and histamine-mediated pruritus. unlike its major metabolite cetirizine, it does cause drowsiness. it is also effective as an antiemetic, for relief of anxiety and tension, and as a sedative.
  • Loxapine

    an antipsychotic agent used in schizophrenia.
  • Meprobamate

    a carbamate with hypnotic, sedative, and some muscle relaxant properties, although in therapeutic doses reduction of anxiety rather than a direct effect may be responsible for muscle relaxation. meprobamate has been reported to have anticonvulsant actions against petit mal seizures, but not against grand mal seizures (which may be exacerbated). it is used in the treatment of anxiety disorders, and also for the short-term management of insomnia but has largely been superseded by the benzodiazepines. (from martindale, the extra pharmacopoeia, 30th ed, p603)
  • Molindone

    an indole derivative effective in schizophrenia and other psychoses and possibly useful in the treatment of the aggressive type of undersocialized conduct disorder. molindone has much lower affinity for d2 receptors than most antipsychotic agents and has a relatively low affinity for d1 receptors. it has only low to moderate affinity for cholinergic and alpha-adrenergic receptors. some electrophysiologic data from animals indicate that molindone has certain characteristics that resemble those of clozapine. (from ama drug evaluations annual, 1994, p283)
  • Olanzapine

    a benzodiazepine derivative that binds serotonin receptors; muscarinic receptors; histamine h1 receptors; adrenergic alpha-1 receptors; and dopamine receptors. it is an antipsychotic agent used in the treatment of schizophrenia; bipolar disorder; and major depressive disorder; it may also reduce nausea and vomiting in patients undergoing chemotherapy.
  • Penfluridol

    one of the long-acting antipsychotic agents used for maintenance or long-term therapy of schizophrenia and other psychotic disorders.
  • Pimozide

    a diphenylbutylpiperidine that is effective as an antipsychotic agent and as an alternative to haloperidol for the suppression of vocal and motor tics in patients with tourette syndrome. although the precise mechanism of action is unknown, blockade of postsynaptic dopamine receptors has been postulated. (from ama drug evaluations annual, 1994, p403)
  • Raclopride

    a substituted benzamide that has antipsychotic properties. it is a dopamine d2 receptor (see receptors, dopamine d2) antagonist.
  • Remoxipride

    an antipsychotic agent that is specific for dopamine d2 receptors. it has been shown to be effective in the treatment of schizophrenia.
  • Sulpiride

    a dopamine d2-receptor antagonist. it has been used therapeutically as an antidepressant, antipsychotic, and as a digestive aid. (from merck index, 11th ed)
  • Tetrabenazine

    a drug formerly used as an antipsychotic and treatment of various movement disorders. tetrabenazine blocks neurotransmitter uptake into adrenergic storage vesicles and has been used as a high affinity label for the vesicle transport system.

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 psychotropic drugs, not elsewhere classified (T43). 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)

T43.596D 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 T43.596D to ICD-9-CM

  • ICD-9-CM Code: -
    No Map Flag -

Table of Drugs and Chemicals

The parent code T43.596 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
AminophenylpyridoneT43.591T43.592T43.593T43.594T43.595T43.596
AmisulprideT43.591T43.592T43.593T43.594T43.595T43.596
AmperozideT43.591T43.592T43.593T43.594T43.595T43.596
AmphenidoneT43.591T43.592T43.593T43.594T43.595T43.596
AzacyclonolT43.591T43.592T43.593T43.594T43.595T43.596
BenzperidinT43.591T43.592T43.593T43.594T43.595T43.596
BenzperidolT43.591T43.592T43.593T43.594T43.595T43.596
BuspironeT43.591T43.592T43.593T43.594T43.595T43.596
Captodiame, captodiamineT43.591T43.592T43.593T43.594T43.595T43.596
ClotiapineT43.591T43.592T43.593T43.594T43.595T43.596
DroperidolT43.591T43.592T43.593T43.594T43.595T43.596
EmylcamateT43.591T43.592T43.593T43.594T43.595T43.596
EnpiprazoleT43.591T43.592T43.593T43.594T43.595T43.596
EquanilT43.591T43.592T43.593T43.594T43.595T43.596
FluspirileneT43.591T43.592T43.593T43.594T43.595T43.596
HydroxyphenamateT43.591T43.592T43.593T43.594T43.595T43.596
HydroxyzineT43.591T43.592T43.593T43.594T43.595T43.596
LoxapineT43.591T43.592T43.593T43.594T43.595T43.596
MebutamateT43.591T43.592T43.593T43.594T43.595T43.596
MeprobamT43.591T43.592T43.593T43.594T43.595T43.596
MeprobamateT43.591T43.592T43.593T43.594T43.595T43.596
MiltownT43.591T43.592T43.593T43.594T43.595T43.596
MolindoneT43.591T43.592T43.593T43.594T43.595T43.596
MosapramineT43.591T43.592T43.593T43.594T43.595T43.596
NemonaprideT43.591T43.592T43.593T43.594T43.595T43.596
OlanzapineT43.591T43.592T43.593T43.594T43.595T43.596
OxanamideT43.591T43.592T43.593T43.594T43.595T43.596
OxypertineT43.591T43.592T43.593T43.594T43.595T43.596
PenfluridolT43.591T43.592T43.593T43.594T43.595T43.596
PhenaglycodolT43.591T43.592T43.593T43.594T43.595T43.596
PimozideT43.591T43.592T43.593T43.594T43.595T43.596
ProcalmidolT43.591T43.592T43.593T43.594T43.595T43.596
ProthipendylT43.591T43.592T43.593T43.594T43.595T43.596
RacloprideT43.591T43.592T43.593T43.594T43.595T43.596
RemoxiprideT43.591T43.592T43.593T43.594T43.595T43.596
SetoperoneT43.591T43.592T43.593T43.594T43.595T43.596
SpirileneT43.591T43.592T43.593T43.594T43.595T43.596
SulpirideT43.591T43.592T43.593T43.594T43.595T43.596
SultoprideT43.591T43.592T43.593T43.594T43.595T43.596
TaractanT43.591T43.592T43.593T43.594T43.595T43.596
TetrabenazineT43.591T43.592T43.593T43.594T43.595T43.596
TiaprideT43.591T43.592T43.593T43.594T43.595T43.596
TybamateT43.591T43.592T43.593T43.594T43.595T43.596
ZotepineT43.591T43.592T43.593T43.594T43.595T43.596
ZyprexaT43.591T43.592T43.593T43.594T43.595T43.596

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


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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.