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ICD-10 Guide
ICD-10 CodesChapter 19: Injury, poisoning and other consequences of external causesT42

T42

Non-billable

Poisoning by, adverse effect of and underdosing of antiepileptic, sedative- hypnotic and antiparkinsonism drugs

Chapter 19:Injury, poisoning and other consequences of external causes

BILLABLE STATUSNo
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 T42 is a used to indicate a diagnosis of poisoning by, adverse effect of and underdosing of antiepileptic, sedative- hypnotic and antiparkinsonism drugs.

Key Diagnostic Point:

The ICD-10 Level 1 Category code T42 encompasses poisoning, adverse effects, and underdosing of antiepileptic, sedative-hypnotic, and antiparkinsonism drugs. This category is critical for documenting incidents related to the misuse or inappropriate administration of these medications, which are commonly prescribed for conditions such as epilepsy, anxiety disorders, and Parkinson's disease. Clinicians must be vigilant in recognizing the signs of poisoning or adverse effects, as these can lead to severe complications, including respiratory depression, altered mental status, or exacerbation of the underlying condition being treated. Accurate coding under T42 ensures that healthcare providers can effectively communicate the severity and nature of these incidents, facilitating appropriate management and intervention strategies.

  • In clinical practice, T42 codes are essential for capturing the complexities associated with medication management in patients receiving antiepileptic, sedative-hypnotic, and antiparkinsonism therapies. The correct application of these codes aids in the identification of trends in medication-related issues, which can inform clinical guidelines and improve patient safety. Furthermore, proper coding under T42 supports healthcare facilities in their quality improvement initiatives and compliance with regulatory standards, ultimately enhancing patient care outcomes and resource allocation within the healthcare system.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of medications covered
  • Potential for misdiagnosis
  • Need for precise documentation

Audit Risk Factors

  • Inadequate documentation of medication history
  • Failure to specify the type of adverse effect
  • Misclassification of the severity of the incident

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Psychiatry

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related CPT Codes

CPT Code

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CPT Code

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CPT Code

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CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical impact of T42 is significant, as it directly relates to patient safety and the management of medication-related issues. Accurate coding can lead to improved monitoring of adverse drug reactions and better understanding of the risks associated with antiepileptic, sedative-hypnotic, and antiparkinsonism medications. This, in turn, can inform clinical practices and guidelines aimed at reducing the incidence of such events, ultimately enhancing patient outcomes.
From an administrative perspective, T42 coding plays a crucial role in quality measurement and population health management. By tracking incidents related to these drug categories, healthcare organizations can identify trends, allocate resources effectively, and implement preventive measures. Furthermore, as healthcare systems increasingly focus on value-based care, the implications of T42 coding extend to healthcare trends, influencing policy decisions and funding for programs aimed at improving medication safety and efficacy.

ICD-9 vs ICD-10

The clinical impact of T42 is significant, as it directly relates to patient safety and the management of medication-related issues. Accurate coding can lead to improved monitoring of adverse drug reactions and better understanding of the risks associated with antiepileptic, sedative-hypnotic, and antiparkinsonism medications. This, in turn, can inform clinical practices and guidelines aimed at reducing the incidence of such events, ultimately enhancing patient outcomes. From an administrative perspective, T42 coding plays a crucial role in quality measurement and population health management. By tracking incidents related to these drug categories, healthcare organizations can identify trends, allocate resources effectively, and implement preventive measures. Furthermore, as healthcare systems increasingly focus on value-based care, the implications of T42 coding extend to healthcare trends, influencing policy decisions and funding for programs aimed at improving medication safety and efficacy.

Reimbursement & Billing Impact

Reimbursement may vary based on the complexity of the case, the level of care provided, and the payer's policies. It is essential to accurately code the diagnosis and any associated procedures to facilitate appropriate reimbursement.

Resources

Clinical References

  • •
    Official ICD-10 Guidelines for T42

Coding & Billing References

  • •
    Official ICD-10 Guidelines for T42

Frequently Asked Questions

What conditions are included in T42?

T42 covers conditions related to poisoning, adverse effects, and underdosing of antiepileptic drugs (such as phenytoin and valproate), sedative-hypnotic medications (like benzodiazepines), and antiparkinsonism drugs (including levodopa and dopamine agonists).

When should I use T42 codes?

T42 codes should be used when a patient presents with symptoms or complications resulting from the misuse, adverse effects, or underdosing of the specified drug categories. This includes cases of overdose, withdrawal symptoms, or ineffective treatment due to inadequate dosing.

What documentation is required for T42?

Documentation for T42 should include a detailed account of the patient's medication history, the specific drug involved, the nature of the adverse effect or poisoning, and any relevant clinical findings. It is crucial to note the context of the incident, including whether it was accidental, intentional, or due to underdosing.