Is T36.1X5 a billable ICD-10-CM code?

No. T36.1X5 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does T36.1X5 sit in the tabular list?

Injury, poisoning and certain other consequences of external causes (S00-T88), in the block Poisoning by, adverse effects of and underdosing of drugs, medicaments and biological substances (T36-T50).

What cannot be coded together with T36.1X5?

T36.1X5 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above T36.1X5 (T36) and apply to it just the same.

T36.1X5

T36.1X5 — Adverse effect of cephalosporins and other beta-lactam antibiotics

Non-billable headerICD-10-CM

T36.1X5 is a non-billable header ICD-10-CM code for adverse effect of cephalosporins and other beta-lactam antibiotics. It cannot be billed on its own: choose one of the more specific child codes below. This code also requires a 7th character before it is complete.

This code requires a 7th character

The appropriate 7th character is to be added to each code from category T36

A: initial encounter
D: subsequent encounter
S: sequela

Excludes1 inherited from the categories above T36.1X5

These are not written on T36.1X5, but they bind it: a note on a category applies to every code beneath it. Billing T36.1X5 with anything listed here is a denial.

Written on T36 — Poisoning by, adverse effect of and underdosing of systemic antibiotics

antineoplastic antibiotics (T45.1-)
locally applied antibiotic NEC (T49.0)
topically used antibiotic for ear, nose and throat (T49.6)
topically used antibiotic for eye (T49.5)

Risk adjustment

T36.1X5 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Code history

T36.1X5 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Code to one of these instead T36.1X5

3 child codes. Green means billable.

Related codes at this level

Codes that share T36.1X. If T36.1X5 is not quite right, the correct code is usually one of these.

Questions about T36.1X5

Is T36.1X5 a billable ICD-10-CM code?: No. T36.1X5 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does T36.1X5 sit in the tabular list?: Injury, poisoning and certain other consequences of external causes (S00-T88), in the block Poisoning by, adverse effects of and underdosing of drugs, medicaments and biological substances (T36-T50).
What cannot be coded together with T36.1X5?: T36.1X5 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above T36.1X5 (T36) and apply to it just the same.