T61.12XA — Scombroid fish poisoning, intentional self-harm, initial encounter
T61.12XA is a billable, specific ICD-10-CM code for scombroid fish poisoning, intentional self-harm, 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 T61
- A
- initial encounter
- D
- subsequent encounter
- S
- sequela
Excludes1 inherited from the categories above T61.12XA
These are not written on T61.12XA, but they bind it: a note on a category applies to every code beneath it. Billing T61.12XA with anything listed here is a denial.
Written on T61 — Toxic effect of noxious substances eaten as seafood
- allergic reaction to food, such as:
- anaphylactic reaction or shock due to adverse food reaction (T78.0-)
- bacterial foodborne intoxications (A05.-)
- dermatitis (L23.6, L25.4, L27.2)
- food protein-induced enterocolitis syndrome (K52.21)
- food protein-induced enteropathy (K52.22)
- gastroenteritis (noninfective) (K52.29)
- toxic effect of aflatoxin and other mycotoxins (T64)
- toxic effect of cyanides (T65.0-)
- toxic effect of harmful algae bloom (T65.82-)
- toxic effect of hydrogen cyanide (T57.3-)
- toxic effect of mercury (T56.1-)
- toxic effect of red tide (T65.82-)
Risk adjustment
T61.12XA risk-adjusts. Under the CMS-HCC V28 model it maps to these categories:
- HCC 155 Major Depression, Moderate or Severe, without Psychosis0.299 RAF
- HCC 155 Major Depression, Moderate or Severe, without Psychosis0.299 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
T61.12XA 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.
- A56612Billing and Coding: CT of the Head
- A57205Billing and Coding: Oximetry Services
Code history
T61.12XA has not changed since FY2024 — no addition, revision or deletion across the FY2024–FY2027 ICD-10-CM releases.
Related codes at this level
Codes that share T61.12. If T61.12XA is not quite right, the correct code is usually one of these.
Questions about T61.12XA
- Is T61.12XA a billable ICD-10-CM code?
- Yes. T61.12XA is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does T61.12XA sit in the tabular list?
- Injury, poisoning and certain other consequences of external causes (S00-T88), in the block Toxic effects of substances chiefly nonmedicinal as to source (T51-T65).
- What cannot be coded together with T61.12XA?
- T61.12XA 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 T61.12XA (T61) and apply to it just the same.