ICD-10-CM Diagnosis Code T36.95XS - Adverse effect of unspecified systemic antibiotic, sequela (original) (raw)

ICD List 2025-2026 Edition

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2. ICD-10-CM Codes
3. S00–T88
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6. 2026 ICD-10-CM Code T36.95XS

Adverse effect of unspecified systemic antibiotic, sequela

ICD-10-CM Code:

T36.95XS

ICD-10 Code for:

Adverse effect of unspecified systemic antibiotic, sequela

Is Billable?

Yes - Valid for Submission

Chronic Condition Indicator: [1]

Not chronic

Code Navigator:

T36.95XS is a billable diagnosis code used to specify a medical diagnosis of adverse effect of unspecified systemic antibiotic, sequela. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2025 through September 30, 2026. The code is exempt from present on admission (POA) reporting for inpatient admissions to general acute care hospitals.

This code describes a circumstance which influences the patient's health status but not a current illness or injury. The code is unacceptable as a principal diagnosis.

T36.95XS is a sequela code, includes a 7th character and should be used for complications that arise as a direct result of a condition like adverse effect of unspecified systemic antibiotic. According to ICD-10-CM Guidelines a "sequela" code should be used for chronic or residual conditions that are complications of an initial acute disease, illness or injury. The most common sequela is pain. Usually, two diagnosis codes are needed when reporting sequela. The first code describes the nature of the sequela while the second code describes the sequela or late effect.

Unspecified diagnosis codes like T36.95XS are acceptable when clinical information is unknown or not available about a particular condition. Although a more specific code is preferable, unspecified codes should be used when such codes most accurately reflect what is known about a patient's condition. Specific diagnosis codes should not be used if not supported by the patient's medical record.

1. Code Information
2. Approximate Synonyms
3. Clinical Classification
4. Coding Guidelines
5. Tabular List of Diseases and Injuries
6. Code Edits
7. Diagnostic Related Groups Mapping
8. Present on Admission (POA)
9. Convert to ICD-9 Code
10. Table of Drugs and Chemicals
11. Patient Education
12. Other Codes Used Similar Conditions
13. Code History

• Injury, poisoning and certain other consequences of external causes
  S00–T88
  • Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances
    T36-T50
    * Poisoning by, adverse effect of and underdosing of systemic antibiotics
    T36

The following list of clinical terms are approximate synonyms, alternative descriptions, or common phrases that might be used by patients, healthcare providers, or medical coders to describe the same condition. These synonyms and related diagnosis terms are often used when searching for an ICD-10 code, especially when the exact medical terminology is unclear. Whether you're looking for lay terms, similar diagnosis names, or common language alternatives, this list can help guide you to the correct ICD-10 classification.

• Allergic reaction caused by antibacterial agent
• Allergic reaction caused by antibacterial agent
• Allergic reaction caused by antiinfective agent
• Allergic reaction caused by antiinfective agent
• Anaphylaxis caused by antibacterial agent
• Antibacterial drug adverse reaction
• Antibiotic enterocolitis
• Antibiotic-associated diarrhea
• Antibiotic-induced neuromuscular blocking
• Drug-induced anaphylaxis
• Drug-induced colitis
• Drug-induced enteritis of intestine
• Drug-induced myasthenia
• Fetal disorder caused by antibacterial transmitted via placenta
• Fetal disorder caused by anti-infective agent transmitted via placenta
• Jarisch Herxheimer reaction
• Noninfective enteritis and colitis
• Suppression of microbiota of gastrointestinal tract caused by antibiotic
• Toxic enteritis of small intestine caused by drug
• Toxic neuromuscular junction disorder

Clinical Classifications group individual ICD-10-CM diagnosis codes into broader, clinically meaningful categories. These categories help simplify complex data by organizing related conditions under common clinical themes.

They are especially useful for data analysis, reporting, and clinical decision-making. Even when diagnosis codes differ, similar conditions can be grouped together based on their clinical relevance. Each category is assigned a unique CCSR code that represents a specific clinical concept, often tied to a body system or medical specialty.

CCSR Code: INJ075

Inpatient Default: X - Not applicable.

Outpatient Default: Y - Yes, default outpatient assignment for principal diagnosis or first-listed diagnosis.

When coding an adverse effect of a drug that has been correctly prescribed and properly administered, assign the appropriate code for the nature of the adverse effect followed by the appropriate code for the adverse effect of the drug.

The appropriate 7th character is to be added to each code from block Poisoning by, adverse effect of and underdosing of systemic antibiotics (T36). Use the following options for the aplicable episode of care:

• A - initial encounter
• D - subsequent encounter
• S - sequela

The Medicare Code Editor (MCE) detects errors and inconsistencies in ICD-10-CM diagnosis coding that can affect Medicare claim validity. These Medicare code edits help medical coders and billing professionals determine when a diagnosis code is not appropriate as a principal diagnosis, does not meet coverage criteria. Use this list to verify whether a code is valid for Medicare billing and to avoid claim rejections or denials due to diagnosis coding issues.

There are selected codes that describe a circumstance which influences an individual's health status but not a current illness or injury, or codes that are not specific manifestations but may be due to an underlying cause. These codes are considered unacceptable as a principal diagnosis.

T36.95XS is exempt from POA reporting - The Present on Admission (POA) indicator is used for diagnosis codes included in claims involving inpatient admissions to general acute care hospitals. POA indicators must be reported to CMS on each claim to facilitate the grouping of diagnoses codes into the proper Diagnostic Related Groups (DRG). CMS publishes a listing of specific diagnosis codes that are exempt from the POA reporting requirement. Review other POA exempt codes here.

CMS POA Indicator Options and Definitions

POA Indicator: Y

Reason: Diagnosis was present at time of inpatient admission.

CMS Pays CC/MCC DRG? YES

POA Indicator: N

Reason: Diagnosis was not present at time of inpatient admission.

CMS Pays CC/MCC DRG? NO

POA Indicator: U

Reason: Documentation insufficient to determine if the condition was present at the time of inpatient admission.

CMS Pays CC/MCC DRG? NO

POA Indicator: W

Reason: Clinically undetermined - unable to clinically determine whether the condition was present at the time of inpatient admission.

CMS Pays CC/MCC DRG? YES

POA Indicator: 1

Reason: Unreported/Not used - Exempt from POA reporting.

CMS Pays CC/MCC DRG? NO

Below are the ICD-9 codes that most closely match this ICD-10 code, based on the General Equivalence Mappings (GEMs). This ICD-10 to ICD-9 crosswalk tool is helpful for coders who need to reference legacy diagnosis codes for audits, historical claims, or approximate code comparisons.

ICD-9-CM: 909.5

Approximate Flag - The approximate mapping means this ICD-10 code does not have an exact ICD-9 equivalent. The matched code is the closest available option, but it may not fully capture the original diagnosis or clinical intent.

ICD-9-CM: E930.8

Approximate Flag - The approximate mapping means this ICD-10 code does not have an exact ICD-9 equivalent. The matched code is the closest available option, but it may not fully capture the original diagnosis or clinical intent.

The parent code T36.95 of the current diagnosis code is referenced in the Table of Drugs and Chemicals, this table contains a classification of drugs, industrial solvents, corrosive gases, noxious plants, pesticides, and other toxic agents.

According to ICD-10-CM coding guidelines it is advised to do not code directly from the Table of Drugs and Chemicals, instead always refer back to the Tabular List when doing the initial coding. Each substance in the table is assigned a code according to the poisoning classification and external causes of adverse effects. It is important to use as many codes as necessary to specify all reported drugs, medicinal or chemical substances. If the same diagnosis code describes the causative agent for more than one adverse reaction, poisoning, toxic effect or underdosing, utilize the code only once.

Filter table of drugs and chemicals:

Drug Reactions

Most of the time, medicines make our lives better. They reduce aches and pains, fight infections, and control problems such as high blood pressure or diabetes. But medicines can also cause unwanted reactions, such as drug interactions, side effects, and allergies.

What is a drug interaction?

A drug interaction is a change in the way a drug acts in the body when taken with certain other drugs, foods, or supplements or when taken while you have certain medical conditions. Examples include:

• Two drugs, such as aspirin and blood thinners
• Drugs and food, such as statins and grapefruit
• Drugs and supplements, such as gingko and blood thinners
• Drugs and medical conditions, such as aspirin and peptic ulcers

Interactions could cause a drug to be more or less effective, cause side effects, or change the way one or both drugs work.

What are side effects?

Side effects are unwanted, usually unpleasant, effects caused by medicines. Most are mild, such as a stomachache, dry mouth, or drowsiness, and go away after you stop taking the medicine. Others can be more serious. Sometimes a drug can interact with a disease that you have and cause a side effect. For example, if you have a heart condition, certain decongestants can cause you to have a rapid heartbeat.

What are drug allergies?

Drug allergies are another type of reaction. They can range from mild to life-threatening. Skin reactions, such as hives and rashes, are the most common type. Anaphylaxis, a serious allergic reaction, is less common.

How can I stay safe when taking medicines?

When you start a new prescription or over-the-counter medicine, make sure you understand how to take it correctly. Know which other medicines, foods, and supplements you need to avoid. Always talk to your health care provider or pharmacist if you have questions about your medicines.

[Learn More in MedlinePlus]

• FY 2026 - No Change, effective from 10/1/2025 through 9/30/2026

• FY 2025 - No Change, effective from 10/1/2024 through 9/30/2025

• FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024

• FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023

• FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022

• FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021

• FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020

• FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019

• FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018

• FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017

• FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. This was the first year ICD-10-CM was implemented into the HIPAA code set.

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• Parent Code: T36.95

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