BETA v.3.0

2025 ICD-10-CM code T36.0X5A

Adverse effect of penicillins, initial encounter.

Follow official ICD-10-CM guidelines for coding adverse effects of drugs.Always code the nature of the adverse effect in addition to T36.0X5A. The seventh character (A for initial encounter, D for subsequent encounters) must be included.

Modifiers may be applicable depending on the circumstances of service.Consult your local payer guidelines.

The medical necessity is established by the occurrence of the adverse reaction to the penicillin, requiring diagnosis and potentially treatment.

The physician or other qualified healthcare professional responsible for diagnosing and managing the patient's adverse reaction to penicillin.

IMPORTANT:If the adverse reaction is to a cephalosporin or other beta-lactam antibiotic, consider T36.1X5A.If the patient has a history of penicillin allergy, Z88.0 (Personal history of penicillin allergy) may be appropriate in addition to a code describing the current reaction.For subsequent encounters, use the same code with the seventh character changed to 'D'.Always code the specific adverse effect in addition to the drug-related code.

In simple words: This code describes a bad reaction to penicillin, even if the penicillin was taken correctly as prescribed. This is for the first time this reaction happened.

This code is used to classify an adverse effect occurring as a result of penicillin administration,representing the initial encounter with this complication.It's crucial to note that the penicillin must have been correctly prescribed and administered; if misuse is involved, different poisoning codes apply. The seventh character 'A' signifies the initial encounter. Subsequent encounters require using 'D' as the seventh character.

Example 1: A patient develops a generalized rash and itching after receiving a prescribed dose of penicillin for a respiratory infection.This is the patient's first experience with this reaction., A patient experiences anaphylaxis (severe allergic reaction) following an injection of penicillin. This is the first time this has occurred., A patient develops mild hives after taking amoxicillin as prescribed.This is a first-time occurrence.

Detailed documentation of the penicillin administration (type, dose, route, and date),a clear description of the adverse reaction (symptoms, severity, timing), and any treatment provided.The documentation should confirm that the medication was prescribed and administered appropriately.

** This code is part of a broader category that includes adverse effects of various drugs. Always verify that the penicillin was properly administered and prescribed; if not, poisoning codes should be considered instead.

  • Payment Status: Active
  • Modifier TC rule: Not applicable to this diagnosis code.
  • Specialties:Allergy and Immunology, Infectious Disease, Internal Medicine, Family Medicine
  • Place of Service:Office, Hospital Inpatient, Hospital Outpatient, Emergency Room, Urgent Care
** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.