T43.015 vs T43.016
T43.015 (Adverse effect of tricyclic antidepressants) compared with T43.016 (Underdosing of tricyclic antidepressants), from the official CMS tabular data. T43.015 and T43.016 code the same substance (Allegron) with a different intent.
Can these codes be reported together?
Same substance, different intent. T43.015 and T43.016 code the same substance (Allegron) with a different circumstance of exposure.
From the CMS Table of Drugs and Chemicals: accidental poisoning, intentional self-harm, assault, undetermined intent, adverse effect and underdosing are mutually exclusive columns — only one of them applies to a given encounter.
Side by side
| T43.015Adverse effect of tricyclic antidepressants | T43.016Underdosing of tricyclic antidepressants | |
|---|---|---|
| Billing status | Non-billable header | Non-billable header |
| 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 | Adverse effect of tricyclic antidepressants is a non-billable ICD-10-CM category code (T43.015). | Underdosing of tricyclic antidepressants is a non-billable ICD-10-CM category code (T43.016). |
| 7th character | The appropriate 7th character is to be added to each code from category T43 | 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