2025 ICD-10-CM code T38.5X5D
Adverse effect of other estrogens and progestogens, subsequent encounter.
Medical necessity is established by the provider's documentation of the adverse effect, its relationship to the estrogen and/or progestogen medication, and the need for continued management or intervention due to the adverse reaction.
The provider is responsible for documenting the specific adverse effects experienced by the patient, the relationship to the estrogen and progestogen medication, and any treatment provided for the adverse reaction.
In simple words: This code indicates a negative reaction experienced after a subsequent encounter (not the initial encounter) with estrogen and progestogen medications, excluding those used as mineralocorticoids, oxytocic hormones, or parathyroid-related substances.
Adverse effect of other estrogens and progestogens, subsequent encounter.
Example 1: A patient who previously experienced mild nausea after starting a combined estrogen and progestogen hormone replacement therapy presents for a follow-up appointment. She reports continued nausea and now also experiences breast tenderness. The provider adjusts the medication dosage and monitors the patient for further adverse effects. T38.5X5D is used to code the subsequent encounter for the adverse effects of the hormone therapy., A patient on long-term estrogen and progestogen therapy for menopausal symptoms develops vaginal bleeding. This is her second visit related to this issue. After examination, the provider determines it to be a breakthrough bleeding, a known side effect of the medication. The provider reassures the patient and advises her to continue monitoring the bleeding. T38.5X5D is used to code this subsequent encounter for the adverse effect., A patient taking an estrogen and progestogen contraceptive pill presents with a deep vein thrombosis (DVT). This is her second visit for this complication and requires continued treatment. The provider confirms the diagnosis and continues the prescribed anticoagulant therapy. T38.5X5D is used to code the subsequent encounter for the adverse effect of the contraceptive pill, and an additional code is used for the DVT.
Documentation should clearly link the adverse effect to the estrogen/progestogen use, specify the nature of the adverse effect (e.g., nausea, bleeding, DVT), and outline the treatment provided or planned. Previous related encounters should be noted, establishing this as a subsequent encounter. Any medications prescribed or adjusted should be documented.
** For initial encounters for adverse effects, use T38.5X5A. For sequelae of adverse effects, use T38.5X5S.This code is not to be used as a principal diagnosis.
- Specialties:Gynecology, Endocrinology, Family Medicine, Internal Medicine.
- Place of Service:Office, Inpatient Hospital, Outpatient Hospital