T40.994A: Poisoning by other psychodysleptics [hallucinogens], undetermined, initial encounter
T40.994A is a billable, specific ICD-10-CM code for poisoning by other psychodysleptics [hallucinogens], undetermined, initial encounter. It is valid for submission on a claim.
Check T40.994A with the rest of the claim: free scrubber7th 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
Excludes2 inherited from the categories above T40.994A
Not part of this code, but both may be coded when both are present.
Risk adjustment
T40.994A 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. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
T40.994A is named in 9 Medicare coverage policies: 9 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A54799Billing and Coding: Urine Drug Testing
- A55001Billing and Coding: Urine Drug Testing
- A56612Billing and Coding: CT of the Head
- A56645Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
Code history
Unchanged in every release from FY2024 to FY2027.