T42.6X1A — Poisoning by other antiepileptic and sedative-hypnotic drugs, accidental (unintentional), initial encounter
T42.6X1A is a billable, specific ICD-10-CM code for poisoning by other antiepileptic and sedative-hypnotic drugs, accidental (unintentional), 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 T42
- A
- initial encounter
- D
- subsequent encounter
- S
- sequela
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Poisoning by other antiepileptic and sedative-hypnotic drugs NOS
Risk adjustment
T42.6X1A 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
T42.6X1A is named in 12 Medicare coverage policies — 12 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
- A56612Billing and Coding: CT of the Head
- A56645Billing and Coding: Controlled Substance Monitoring and Drugs of Abuse Testing
Related codes at this level
Codes that share T42.6X1. If T42.6X1A is not quite right, the correct code is usually one of these.
Questions about T42.6X1A
- Is T42.6X1A a billable ICD-10-CM code?
- Yes. T42.6X1A is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does T42.6X1A 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).