P96 vs T42
P96 (Other conditions originating in the perinatal period) compared with T42 (Poisoning by, adverse effect of and underdosing of antiepileptic, sedative- hypnotic and antiparkinsonism drugs), from the official CMS tabular data. Both may be reported when both conditions are documented (Excludes2).
Can these codes be reported together?
Yes, when both are documented. T42 carries an Excludes2 note covering P96: “drug reaction and poisoning affecting newborn (P00-P96)”
Excludes2 marks distinct conditions — both may be reported when both are documented.
Side by side
| P96Other conditions originating in the perinatal period | T42Poisoning by, adverse effect of and underdosing of antiepileptic, sedative- hypnotic and antiparkinsonism drugs | |
|---|---|---|
| Billing status | Non-billable header | Non-billable header Report instead: T42.0X1A, T42.0X1D, T42.0X1S, T42.0X2A, T42.0X2D |
| Classification | P00-P96 — Certain Conditions Originating in the Perinatal Period (P00-P96) | S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) |
| Definition | Other conditions originating in the perinatal period is a non-billable ICD-10-CM category code (P96). | Poisoning by, adverse effect of and underdosing of antiepileptic, sedative- hypnotic and antiparkinsonism drugs is a non-billable ICD-10-CM category code (T42). |
| 7th character | — | The appropriate 7th character is to be added to each code from category T42 |
| Includes | — | 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 |
| Use additional code | — | code(s) to specify: manifestations of poisoning underdosing or failure in dosage during medical and surgical care (Y63.6, Y63.8-Y63.9) |
| Code first | — | , for adverse effects, the nature of the adverse effect, such as: adverse effect NOS (T88.7) |
Derived from the official CMS ICD-10-CM tabular data (FY2026). Not billing advice; verify sequencing rules for the encounter. All data sources