T38.6X2S ICD-10-CM Code: Poisoning by antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, intentional self-harm, sequela
T38.6X2S is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · free HCC coding tools
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FY 2026 Apr update / Injury, poisoning and certain other consequences of external causes (S00-T88) / Poisoning by, adverse effects of and underdosing of drugs, medicaments and biological substances (T36-T50)
T38.6X2S
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePoisoning by antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, intentional self-harm, sequela
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
N/A—
Not mapped
ESRD/PACE
MappedHCC 59
Code-level coefficient reference
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
Official- Poisoning by, adverse effect of and underdosing of tamoxifenInherited from T38.6
Excludes 2
Official- birth trauma (P10-P15)Inherited from S00-T88, T36-T50
- obstetric trauma (O70-O71)Inherited from S00-T88, T36-T50
- abuse and dependence of psychoactive substances (F10-F19)Inherited from S00-T88, T36-T50
- abuse of non-dependence-producing substances (F55.-)Inherited from S00-T88, T36-T50
- immunodeficiency due to drugs (D84.821)Inherited from S00-T88, T36-T50
- drug reaction and poisoning affecting newborn (P00-P96)Inherited from S00-T88, T36-T50
- pathological drug intoxication (inebriation) (F10-F19)Inherited from S00-T88, T36-T50
Related Codes
Includes
Official- adverse effect of correct substance properly administeredInherited from T36-T50
- poisoning by overdose of substanceInherited from T36-T50
- poisoning by wrong substance given or taken in errorInherited from T36-T50
- underdosing by (inadvertently) (deliberately) taking less substance than prescribed or instructedInherited from T36-T50
Excludes 1
Official- toxic reaction to local anesthesia in pregnancy (O29.3-)Inherited from T36-T50, T38
- mineralocorticoids and their antagonists (T50.0-)Inherited from T36-T50, T38
- oxytocic hormones (T48.0-)Inherited from T36-T50, T38
- parathyroid hormones and derivatives (T50.9-)Inherited from T36-T50, T38
Code First
Official- , for adverse effects, the nature of the adverse effect, such as:Inherited from T36-T50
- adverse effect NOS (T88.7)Inherited from T36-T50
- aspirin gastritis (K29.-)Inherited from T36-T50
- blood disorders (D56-D76)Inherited from T36-T50
- contact dermatitis (L23-L25)Inherited from T36-T50
- dermatitis due to substances taken internally (L27.-)Inherited from T36-T50
- nephropathy (N14.0-N14.2)Inherited from T36-T50
Use Additional
Official- code to identify any retained foreign body, if applicable (Z18.-)Inherited from S00-T88, T36-T50
- code(s) to specify:Inherited from S00-T88, T36-T50
- manifestations of poisoningInherited from S00-T88, T36-T50
- underdosing or failure in dosage during medical and surgical care (Y63.6, Y63.8-Y63.9)Inherited from S00-T88, T36-T50
- underdosing of medication regimen (Z91.12-, Z91.13-)Inherited from S00-T88, T36-T50
Code Also
OfficialNo Code Also instructions are included in this display for T38.6X2S. Check the code and parent instructions in the Code Book.
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is T38.6X2S an HCC code?
T38.6X2S has no mapping under the current CMS-HCC V28 community payment model. T38.6X2S has a separate mapping under the CMS-HCC ESRD model (HCC 59 (Major Depressive/Bipolar/and Paranoid Disorders)); the applicable result needs member context.
- Code
- T38.6X2S
- Description
- Poisoning by antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, intentional self-harm, sequela
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work T38.6X2S in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for T38.6X2S
For T38.6X2S, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Coder workflow notes
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What This Code Means
T38.6X2S is the ICD-10-CM diagnosis code for poisoning by antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, intentional self-harm, sequela. T38.6X2S sits in the ICD-10-CM chapter for injury, poisoning and certain other consequences of external causes (s00-t88), within the section covering poisoning by, adverse effects of and underdosing of drugs, medicaments and biological substances (t36-t50).
T38.6X2S has no mapping under the current CMS-HCC V28 community payment model. T38.6X2S has a separate mapping under the CMS-HCC ESRD model (HCC 59 (Major Depressive/Bipolar/and Paranoid Disorders)); the applicable result needs member context. Do not assign V28 risk adjustment value from this page; verify the applicable model and payment year before using this code for risk adjustment.
T38.6X2S is a billable ICD-10-CM code, but no current CMS-HCC V28 community payment mapping is shown. It does map under the CMS-HCC ESRD model, and that result depends on member context rather than on the V28 community model. Do not assign risk adjustment value from this page when no source-backed mapping is shown. Coders should check the current model files and select only the specificity supported by the provider documentation.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for T38.6X2S sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

