T50.995A — Adverse effect of other drugs, medicaments and biological substances, initial encounter
T50.995A is a billable, specific ICD-10-CM code for adverse effect of other drugs, medicaments and biological substances, 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 T50
- A
- initial encounter
- D
- subsequent encounter
- S
- sequela
Risk adjustment
T50.995A 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
T50.995A is named in 31 Medicare coverage policies — 31 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A52421Billing and Coding: Ibandronate Sodium
- A52450Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)
- A56531Billing and Coding: Octreotide Acetate for Injectable Suspension (Sandostatin® LAR Depot)
- A56538Billing and Coding: Allergen Immunotherapy
Related codes at this level
Codes that share T50.995. If T50.995A is not quite right, the correct code is usually one of these.
Questions about T50.995A
- Is T50.995A a billable ICD-10-CM code?
- Yes. T50.995A is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does T50.995A 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).