T42.6 vs T43
T42.6 (Poisoning by, adverse effect of and underdosing of other antiepileptic and sedative-hypnotic drugs) compared with T43 (Poisoning by, adverse effect of and underdosing of psychotropic drugs, not elsewhere classified), 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. T43 carries an Excludes2 note covering T42.6: “methaqualone (T42.6-)”
Excludes2 marks distinct conditions — both may be reported when both are documented.
Side by side
| T42.6Poisoning by, adverse effect of and underdosing of other antiepileptic and sedative-hypnotic drugs | T43Poisoning by, adverse effect of and underdosing of psychotropic drugs, not elsewhere classified | |
|---|---|---|
| Billing status | Non-billable header Report instead: T42.6X1A, T42.6X1D, T42.6X1S, T42.6X2A, T42.6X2D | Non-billable header Report instead: T43.011A, T43.011D, T43.011S, T43.012A, T43.012D |
| Classification | S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) | S00-T88 — Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) |
| Definition | Poisoning by, adverse effect of and underdosing of other antiepileptic and sedative-hypnotic drugs is a non-billable ICD-10-CM category code (T42.6). | Poisoning by, adverse effect of and underdosing of psychotropic drugs, not elsewhere classified is a non-billable ICD-10-CM category code (T43). |
| 7th character | The appropriate 7th character is to be added to each code from category T42 | The appropriate 7th character is to be added to each code from category T43 |
| 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 | 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(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) | , 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