2025 ICD-10-CM code T39.4X5

Adverse effect of antirheumatics, not elsewhere classified.

Consult the official ICD-10-CM coding guidelines for complete instructions on coding adverse effects of drugs and medications.Always use additional codes to specify the causative drug (T36-T50) and the nature of the adverse effect.

Modifiers may apply depending on the specific circumstances and the services provided.Consult the appropriate guidelines for modifier usage.

Medical necessity for coding T39.4X5 is established when a patient experiences a clinically significant adverse effect attributable to an antirheumatic drug, requiring medical intervention.

The physician is responsible for documenting the patient's symptoms, conducting a thorough history, performing a physical examination, ordering appropriate tests, diagnosing the adverse reaction, and managing the patient's care.

IMPORTANT Use additional codes from T36-T50 (with 5th or 6th character 5) to specify the antirheumatic drug and codes from other chapters to specify the nature of the adverse effect (e.g., gastrointestinal, hematologic, dermatologic).

In simple words: This code is for bad reactions to medicines used to treat arthritis, not including those already listed separately. The doctor should list which specific medicine caused the reaction.

This code classifies adverse effects resulting from the use of antirheumatic drugs, excluding those specifically listed elsewhere.It's crucial to identify the specific antirheumatic drug involved using additional codes from categories T36-T50 (with fifth or sixth character 5) to pinpoint the causative agent and its adverse effect.

Example 1: A 60-year-old female patient presents with gastrointestinal upset (nausea, vomiting, abdominal pain) after initiating a new course of methotrexate for rheumatoid arthritis.The physician documents the adverse effect and codes T39.4X5 and a code from the appropriate gastrointestinal category., A 55-year-old male patient develops a rash and pruritus after starting treatment with leflunomide for psoriatic arthritis. The physician documents the skin reaction, orders relevant labs, and codes T39.4X5 and a code from the dermatologic category., A 70-year-old female patient experiences an increase in liver enzymes after initiating hydroxychloroquine for rheumatoid arthritis.The physician documents abnormal liver function tests, orders additional testing to clarify the cause, and codes T39.4X5 and a code from the hepatic category.

Complete documentation includes the patient's history, physical examination findings, diagnosis of the adverse effect, the specific antirheumatic drug used, results of relevant laboratory tests, and the management plan.

** When coding adverse effects of antirheumatic medications, ensure that all aspects of the adverse event are documented thoroughly and appropriately coded.

  • Payment Status: Active
  • Modifier TC rule: A TC modifier may or may not be applicable depending on the specifics of the situation and services rendered.Always adhere to the guidelines for TC modifier use.
  • Specialties:Rheumatology, Internal Medicine, Family Medicine
  • Place of Service:Office, Hospital Inpatient, Hospital Outpatient, Emergency Room
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