ICD-10 T36
Non-Billable HeaderPoisoning by, adverse effect of and underdosing of systemic antibiotics
About ICD-10-CM T36
ICD-10-CM code T36 represents Poisoning by, adverse effect of and underdosing of systemic antibiotics. This is a non-billable header code in the Injury, Poisoning, and External Causes chapter (block T36). The 2026 edition of ICD-10-CM T36 became effective on October 1, 2025. Non-billable codes cannot be used as a primary or secondary diagnosis on a claim, use a more specific child code instead.
Coding Tips for T36
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
Injury codes require a 7th character: A (initial encounter, active treatment), D (subsequent, healing/recovery), S (sequela, late effect of original injury). Codes with fewer than 6 characters need the placeholder X to bring them to 6 characters before adding the 7th. Wrong or missing 7th character is the #1 cause of injury claim denials.
Type 1 Excludes
Pure excludes, these codes can never be coded together with T36. The conditions are mutually exclusive (e.g., congenital vs acquired forms).
- antineoplastic antibiotics (T45.1-)
- locally applied antibiotic NEC (T49.0)
- topically used antibiotic for ear, nose and throat (T49.6)
- topically used antibiotic for eye (T49.5)
Coding Notes
Seven Chr Note
- The appropriate 7th character is to be added to each code from category T36
Medicare LCD Coverage for T36
Local Coverage Determinations (LCDs) from CMS MACs that list T36 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing T36.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but T36 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with T36
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Codes Adjacent To T36
Other codes in section T36-T50 (Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances).
ICD-10 T36, Billing FAQ
Is ICD-10 code T36 billable? +
No, T36 is a non-billable header code. Use a more specific child code from block T36 when submitting claims.
What codes are Type 1 Excludes for T36? +
Type 1 Excludes (never code together with T36): antineoplastic antibiotics (T45.1-); locally applied antibiotic NEC (T49.0); topically used antibiotic for ear, nose and throat (T49.6)
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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