T40.494A — Poisoning by other synthetic narcotics, undetermined, initial encounter
T40.494A is a billable, specific ICD-10-CM code for poisoning by other synthetic narcotics, undetermined, 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 T40
- A
- initial encounter
- D
- subsequent encounter
- S
- sequela
Risk adjustment
T40.494A risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 137 Drug Use Disorder, Moderate/Severe, or Drug Use with Non-Psychotic Complications0.424 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.
Medicare coverage
T40.494A is named in 14 Medicare coverage policies — 14 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A54799Billing and Coding: Urine Drug Testing
- A55001Billing and Coding: Urine Drug Testing
- A56500Billing and Coding: Cardiac Catheterization and Coronary Angiography
- A56500Billing and Coding: Cardiac Catheterization and Coronary Angiography
Related codes at this level
Codes that share T40.494. If T40.494A is not quite right, the correct code is usually one of these.
Questions about T40.494A
- Is T40.494A a billable ICD-10-CM code?
- Yes. T40.494A is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does T40.494A 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).