T36.1X5S — Adverse effect of cephalosporins and other beta-lactam antibiotics, sequela
T36.1X5S is a billable, specific ICD-10-CM code for adverse effect of cephalosporins and other beta-lactam antibiotics, sequela. It is valid for submission on a claim.
7th character "S" — sequela
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 T36.1X5S
These are not written on T36.1X5S, but they bind it: a note on a category applies to every code beneath it. Billing T36.1X5S with anything listed here is a denial.
Risk adjustment
T36.1X5S 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.
Medicare coverage
T36.1X5S is named in 37 Medicare coverage policies — 37 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A56538Billing and Coding: Allergen Immunotherapy
- A56558Billing and Coding: Allergy Testing
- A56558Billing and Coding: Allergy Testing
- A56625Billing and Coding: Echocardiography
Code history
T36.1X5S has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.
Related codes at this level
Codes that share T36.1X5. If T36.1X5S is not quite right, the correct code is usually one of these.
Questions about T36.1X5S
- Is T36.1X5S a billable ICD-10-CM code?
- Yes. T36.1X5S is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does T36.1X5S 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 T36.1X5S?
- T36.1X5S 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 T36.1X5S (T36) and apply to it just the same.