2025 ICD-10-CM code T40.2
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Injury, poisoning and certain other consequences of external causes - Poisoning by, adverse effects of and underdosing of drugs, medicaments and biological substances Chapter 19: Injury, poisoning and certain other consequences of external causes Feed
Poisoning by, adverse effect of, and underdosing of other opioids.
Modifiers may be applicable depending on the specific circumstances and the place of service.Consult local payer guidelines for clarification.
Medical necessity for the treatment of opioid poisoning, adverse effects, or underdosing is established by the clinical presentation of symptoms consistent with such events.This would necessitate medical evaluation and appropriate interventions. In cases of overdose, treatment may include naloxone administration, supportive care, and other interventions to mitigate the adverse effects of the opioid.
The clinical responsibility for this code will vary depending on the setting and circumstances. It may involve emergency medicine physicians, hospitalists, critical care specialists, addiction medicine specialists, or other specialists depending on the patient's condition and the treatment required.Documentation should clearly specify the opioid involved, the circumstances of ingestion, the clinical presentation, and the treatment administered.
In simple words: This code is used when someone gets sick or has a bad reaction from taking too much or too little of an opioid drug (like codeine or oxycodone), or when there's an unexpected reaction to a correct dose.It doesn't include opium, heroin, methadone, or certain other synthetic opioids, which have separate codes.
This code classifies poisoning, adverse effects, or underdosing resulting from the use of opioids other than opium, heroin, methadone, or other specified synthetic opioids.It encompasses a wide range of clinical presentations, from accidental ingestion to intentional overdose, and includes reactions to both prescribed and illicit opioid use.The underlying cause of the adverse effect should be specified using additional codes (e.g., codes from categories T36-T50 with fifth or sixth character 5).
Example 1: A patient presents to the emergency department after accidentally ingesting a large quantity of oxycodone.The patient exhibits respiratory depression, decreased level of consciousness, and pinpoint pupils.T40.2 is used to code the poisoning, with additional codes to specify the specific opioid and the resulting respiratory and CNS depression., A patient on chronic opioid therapy for chronic pain experiences severe constipation, leading to a bowel obstruction requiring surgical intervention. The code T40.2 could be used to document the adverse effect of opioid use.Additional codes would reflect the constipation, bowel obstruction, and the surgical procedure., A patient receiving methadone maintenance therapy for opioid addiction reports experiencing significant withdrawal symptoms due to unintentionally missing a dose. T40.2 could be used to code the underdosing event, along with codes to specify the withdrawal symptoms.
Thorough documentation is crucial.The documentation must specify the opioid involved (name and dosage), the route of administration, the amount ingested (if applicable), the timing of ingestion, and the patient's symptoms.Laboratory results (if available) should also be documented, as well as any interventions, treatments, and patient outcomes.
** This code is part of a broader range of codes that address poisoning, adverse effects, and underdosing of various substances.Always refer to the most current version of the ICD-10-CM coding manual for the most up-to-date guidelines and coding conventions.Always verify coding with the specific payer's guidelines.
- Payment Status: Active
- Specialties:Emergency Medicine, Addiction Medicine, Internal Medicine, Pain Management
- Place of Service:Emergency Room - Hospital, Inpatient Hospital, Office, Urgent Care Facility