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T40.42 ICD-10-CM Code: Poisoning by, adverse effect of and underdosing of tramadol

Billing Status: NO. This is a clinician non-billable / parent hierarchy grouping in the ICD-10-CM system.

Official Registry Overview & Definition

Poisoning by, adverse effect of and underdosing of tramadol is a non-billable ICD-10-CM category code (T40.42). A more specific billable subcode must be selected for claims submission.

Official Tabular Instructional Notes

Sequencing, inclusion, and exclusion notes published for T40.42 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-)

Frequently Compared Codes

The official Excludes notes on T40.42 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
    Poisoning by, adverse effect of and underdosing of tramadol
    FY2021 changes

Verify Before Coding

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

Contextual Map

Every relationship of T40.42 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]

Nearest codes (40)

  • T40 — Poisoning by, adverse effect of and underdosing of narcotics and psychodysleptics [hallucinogens] [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]
  • T40.412D — Poisoning by fentanyl or fentanyl analogs, intentional self-harm, subsequent encounter [Sibling]
  • T40.412S — Poisoning by fentanyl or fentanyl analogs, intentional self-harm, sequela [Sibling]
  • T40.413 — Poisoning by fentanyl or fentanyl analogs, assault [Sibling]
  • T40.413A — Poisoning by fentanyl or fentanyl analogs, assault, initial encounter [Sibling]
  • T40.413D — Poisoning by fentanyl or fentanyl analogs, assault, subsequent encounter [Sibling]
  • and 32 more

Change history

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

Frequently Asked Questions (FAQ) & Clinical Guidance

Can T40.42 be billed directly?

No. T40.42 (Poisoning by, adverse effect of and underdosing of tramadol) is a non-billable ICD-10-CM category code. A more specific billable subcode must be selected based on clinical documentation.

Does T40.42 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 T40.42 in its code family, with their registry titles.

  • T40.415S — Adverse effect of fentanyl or fentanyl analogs, sequela
  • 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
  • T40.421 — Poisoning by tramadol, accidental (unintentional)
  • T40.421A — Poisoning by tramadol, accidental (unintentional), initial encounter
  • T40.421D — Poisoning by tramadol, accidental (unintentional), subsequent encounter
  • T40.421S — Poisoning by tramadol, accidental (unintentional), sequela
  • T40.422 — Poisoning by tramadol, intentional self-harm

View all codes in the T40 family