Is T36.96XA a billable ICD-10-CM code?

Yes. T36.96XA is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does T36.96XA 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 T36.96XA?

T36.96XA 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 T36.96XA (T36) and apply to it just the same.

T36.96XA

T36.96XA — Underdosing of unspecified systemic antibiotic, initial encounter

Billable / specific codeICD-10-CM

T36.96XA is a billable, specific ICD-10-CM code for underdosing of unspecified systemic antibiotic, initial encounter. It is valid for submission on a claim.

7th character "A" — initial encounter

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 T36.96XA

These are not written on T36.96XA, but they bind it: a note on a category applies to every code beneath it. Billing T36.96XA 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

T36.96XA 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

T36.96XA is named in 2 Medicare coverage policies — 2 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A57473Billing and Coding: Allergy Testing
A57473Billing and Coding: Allergy Testing

Code history

T36.96XA 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 T36.96. If T36.96XA is not quite right, the correct code is usually one of these.

Questions about T36.96XA

Is T36.96XA a billable ICD-10-CM code?: Yes. T36.96XA is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does T36.96XA 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 T36.96XA?: T36.96XA 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 T36.96XA (T36) and apply to it just the same.