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T40.415S ICD-10-CM Code: Adverse effect of fentanyl or fentanyl analogs, sequela

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Inpatient Payment Groups (MS-DRG)

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43.0, Appendix B.

  • MS-DRG 922 — OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC (MDC 21)
  • MS-DRG 923 — OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC (MDC 21)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Official Registry Overview & Definition

Adverse effect of fentanyl or fentanyl analogs, sequela is a billable ICD-10-CM diagnosis code (T40.415S).

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for T40.415S in the official ICD-10-CM tabular list.

Includes

Conditions the official ICD-10-CM tabular list includes under this code.

  • 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

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Code First

Underlying conditions that must be sequenced before this code.

  • Code first, for adverse effects, the nature of the adverse effect, such as:
  • adverse effect NOS (T88.7)
  • aspirin gastritis (K29.-)
  • blood disorders (D56-D76)
  • contact dermatitis (L23-L25)
  • dermatitis due to substances taken internally (L27.-)
  • nephropathy (N14.0-N14.2)

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code(s) to specify:
  • manifestations of poisoning
  • underdosing or failure in dosage during medical and surgical care (Y63.6, Y63.8-Y63.9)
  • underdosing of medication regimen (Z91.12-, Z91.13-)

Associated Substances (3)

Substances from the official ICD-10-CM Table of Drugs and Chemicals that map to this code.

  • Alfentanil
  • Fentanyl (analogs)
  • Sufentanil

Frequently Compared Codes

The official Excludes notes on T40.415S name these codes. Each comparison page covers when the two can — or must not — be reported together.

Change history

  • FY2021 — 2020-10-01
    Added to the code set
    Adverse effect of fentanyl or fentanyl analogs, sequela
    FY2021 changes

Verify Before Coding

  • Principal-diagnosis restriction. The Medicare Code Editor lists this code as unacceptable as a principal diagnosis: it describes a circumstance influencing health status rather than a current illness or injury being treated. It is valid as a secondary diagnosis.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim.

Relationships & Classification

Potential MS-DRG Relationships (FY2026)

Not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity.

Named in the grouper logic of 2 MS-DRGs: DRG 922 (MDC 21), DRG 923 (MDC 21).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):INJ075 — Poisoning/toxic effect/adverse effects/underdosing, sequela; MBD034 — Mental and substance use disorders; sequela (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Contextual Map

Every relationship of T40.415S in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Hierarchy

  • S00-T88 — Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) (S00-T88) [Hierarchy]
  • T36-T50 — Poisoning by, adverse effects of and underdosing of drugs, medicaments and biological substances [Hierarchy]
  • T40-T41 — Analgesics & Antipyretics [Hierarchy]

Clinical classification (CCSR)

  • INJ075 — Poisoning/toxic effect/adverse effects/underdosing, sequela [CCSR]
  • MBD034 — Mental and substance use disorders; sequela [CCSR]

Potential MS-DRG

  • DRG 922 — OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC [MS-DRG]: “OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC (MDC 21)”
  • DRG 923 — OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC [MS-DRG]: “OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC (MDC 21)”

MDC crossing · procedures (32029)

  • MDC 21 — Injuries, Poisonings and Toxic Effects of Drugs [MDC crossing]: “Injuries, Poisonings and Toxic Effects of Drugs — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”
  • 0016070 — Bypass Cerebral Ventricle to Nasopharynx with Autologous Tissue Substitute, Open Approach [Same-MDC procedure]: “Bypass Cerebral Ventricle to Nasopharynx with Autologous Tissue Substitute, Open Approach — grouped in MDC 21, the procedure side of this code's crossing.” · check together
  • 0016071 — Bypass Cerebral Ventricle to Mastoid Sinus with Autologous Tissue Substitute, Open Approach [Same-MDC procedure]: “Bypass Cerebral Ventricle to Mastoid Sinus with Autologous Tissue Substitute, Open Approach — grouped in MDC 21, the procedure side of this code's crossing.” · check together
  • 0016072 — Bypass Cerebral Ventricle to Atrium with Autologous Tissue Substitute, Open Approach [Same-MDC procedure]: “Bypass Cerebral Ventricle to Atrium with Autologous Tissue Substitute, Open Approach — grouped in MDC 21, the procedure side of this code's crossing.” · check together
  • 0016073 — Bypass Cerebral Ventricle to Blood Vessel with Autologous Tissue Substitute, Open Approach [Same-MDC procedure]: “Bypass Cerebral Ventricle to Blood Vessel with Autologous Tissue Substitute, Open Approach — grouped in MDC 21, the procedure side of this code's crossing.” · check together
  • 0016074 — Bypass Cerebral Ventricle to Pleural Cavity with Autologous Tissue Substitute, Open Approach [Same-MDC procedure]: “Bypass Cerebral Ventricle to Pleural Cavity with Autologous Tissue Substitute, Open Approach — grouped in MDC 21, the procedure side of this code's crossing.” · check together
  • and 32024 more

Drugs & chemicals

  • Alfentanil — Alfentanil — Adverse Effect [Drug table]: “Alfentanil (Adverse Effect)”
  • Fentanyl (analogs) — Fentanyl (analogs) — Adverse Effect [Drug table]: “Fentanyl (analogs) (Adverse Effect)”
  • Sufentanil — Sufentanil — Adverse Effect [Drug table]: “Sufentanil (Adverse Effect)”

Nearest codes (40)

  • T40 — Poisoning by, adverse effect of and underdosing of narcotics and psychodysleptics [hallucinogens] [Sibling]
  • T40.41 — Poisoning by, adverse effect of and underdosing of fentanyl or fentanyl analogs [Sibling]
  • T40.411 — Poisoning by fentanyl or fentanyl analogs, accidental (unintentional) [Sibling]
  • T40.411A — Poisoning by fentanyl or fentanyl analogs, accidental (unintentional), initial encounter [Sibling]
  • T40.411D — Poisoning by fentanyl or fentanyl analogs, accidental (unintentional), subsequent encounter [Sibling]
  • T40.411S — Poisoning by fentanyl or fentanyl analogs, accidental (unintentional), sequela [Sibling]
  • T40.412 — Poisoning by fentanyl or fentanyl analogs, intentional self-harm [Sibling]
  • T40.412A — Poisoning by fentanyl or fentanyl analogs, intentional self-harm, initial encounter [Sibling]
  • and 32 more

Change history

  • FY2021 — Added to the code set [Change history]

Frequently Asked Questions (FAQ) & Clinical Guidance

Does T40.415S require a 7th character?

Yes. The appropriate 7th character is to be added to each code from category T40.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to T40.415S in its code family, with their registry titles.

  • T40.414D — Poisoning by fentanyl or fentanyl analogs, undetermined, subsequent encounter
  • T40.414S — Poisoning by fentanyl or fentanyl analogs, undetermined, sequela
  • T40.415 — Adverse effect of fentanyl or fentanyl analogs
  • T40.415A — Adverse effect of fentanyl or fentanyl analogs, initial encounter
  • T40.415D — Adverse effect of fentanyl or fentanyl analogs, subsequent encounter
  • T40.416 — Underdosing of fentanyl or fentanyl analogs
  • T40.416A — Underdosing of fentanyl or fentanyl analogs, initial encounter
  • T40.416D — Underdosing of fentanyl or fentanyl analogs, subsequent encounter
  • T40.416S — Underdosing of fentanyl or fentanyl analogs, sequela
  • T40.42 — Poisoning by, adverse effect of and underdosing of tramadol

View all codes in the T40 family