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FY2027 ICD-10-CM reference

T40.1X1: Poisoning by heroin, accidental (unintentional)

By the HCC Buddy Coding Team

The official ICD-10-CM descriptor is Poisoning by heroin, accidental (unintentional). The FY2027 annual edition starts October 1, 2026. Check the edition that applies to the encounter or inpatient discharge, including any April update.

Nonbillable heading. Verified against the official FY2027 order file.

CMS-HCC V28

Not applicable to this nonbillable heading

CMS-HCC V24

Not applicable to this nonbillable heading

ESRD

Not applicable to this nonbillable heading

PACE

Not applicable to this nonbillable heading

RxHCC

Not applicable to this nonbillable heading

HHS-HCC

Not applicable to this nonbillable heading

More specific FY2027 codes

FY2027 Tabular instructions

Instructions below include applicable chapter, section and parent-code notes. Each note identifies where it appears in the official source.

Instructional note

Use secondary code(s) from Chapter 20, External causes of morbidity, to indicate cause of injury. Codes within the T section that include the external cause do not require an additional external cause code

Source: S00-T88 (chapter, inherited).

Instructional note

code to identify any retained foreign body, if applicable (Z18.-)

Source: S00-T88 (chapter, inherited).

Excludes2

birth trauma (P10-P15)

Source: S00-T88 (chapter, inherited).

Excludes2

obstetric trauma (O70-O71)

Source: S00-T88 (chapter, inherited).

Instructional note

The chapter uses the S-section for coding different types of injuries related to single body regions and the T-section to cover injuries to unspecified body regions as well as poisoning and certain other consequences of external causes.

Source: S00-T88 (chapter, inherited).

Includes

adverse effect of correct substance properly administered

Source: T36-T50 (section, inherited).

Includes

poisoning by overdose of substance

Source: T36-T50 (section, inherited).

Includes

poisoning by wrong substance given or taken in error

Source: T36-T50 (section, inherited).

Includes

underdosing by (inadvertently) (deliberately) taking less substance than prescribed or instructed

Source: T36-T50 (section, inherited).

Code first

, for adverse effects, the nature of the adverse effect, such as:

Source: T36-T50 (section, inherited).

Code first

adverse effect NOS (T88.7)

Source: T36-T50 (section, inherited).

Code first

aspirin gastritis (K29.-)

Source: T36-T50 (section, inherited).

Code first

blood disorders (D56-D76)

Source: T36-T50 (section, inherited).

Code first

contact dermatitis (L23-L25)

Source: T36-T50 (section, inherited).

Code first

dermatitis due to substances taken internally (L27.-)

Source: T36-T50 (section, inherited).

Code first

nephropathy (N14.0-N14.2)

Source: T36-T50 (section, inherited).

Instructional note

The drug giving rise to the adverse effect should be identified by use of codes from categories T36-T50 with fifth or sixth character 5.

Source: T36-T50 (section, inherited).

Instructional note

code(s) to specify:

Source: T36-T50 (section, inherited).

Instructional note

manifestations of poisoning

Source: T36-T50 (section, inherited).

Instructional note

underdosing or failure in dosage during medical and surgical care (Y63.6, Y63.8-Y63.9)

Source: T36-T50 (section, inherited).

Instructional note

underdosing of medication regimen (Z91.12-, Z91.13-)

Source: T36-T50 (section, inherited).

Excludes1

toxic reaction to local anesthesia in pregnancy (O29.3-)

Source: T36-T50 (section, inherited).

Excludes2

abuse and dependence of psychoactive substances (F10-F19)

Source: T36-T50 (section, inherited).

Excludes2

abuse of non-dependence-producing substances (F55.-)

Source: T36-T50 (section, inherited).

Excludes2

immunodeficiency due to drugs (D84.821)

Source: T36-T50 (section, inherited).

Excludes2

drug reaction and poisoning affecting newborn (P00-P96)

Source: T36-T50 (section, inherited).

Excludes2

pathological drug intoxication (inebriation) (F10-F19)

Source: T36-T50 (section, inherited).

Excludes2

drug dependence and related mental and behavioral disorders due to psychoactive substance use (F10.-F19.-)

Source: T40 (category, inherited).

Seventh-character instruction

The appropriate 7th character is to be added to each code from category T40

Source: T40 (category, inherited).

Instructional note

initial encounter

Source: T40 (category, inherited).

Instructional note

subsequent encounter

Source: T40 (category, inherited).

Instructional note

sequela

Source: T40 (category, inherited).

Instructional note

Poisoning by heroin NOS

Source: T40.1X1 (self, direct).

Seventh-character definitions

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

Source: CMS FY2027 Tabular List and Alphabetic Index.

Open Tabular instructions and code details

Compare the FY2027 additions, removals and billable-status changes

What does T40.1X1 mean in FY2027?

The official ICD-10-CM descriptor is Poisoning by heroin, accidental (unintentional). The FY2027 annual edition starts October 1, 2026. Check the edition that applies to the encounter or inpatient discharge, including any April update.

Is T40.1X1 billable in FY2027?

The FY2027 order file marks T40.1X1 as a nonbillable heading. Select a complete billable child code.

Does T40.1X1 map to an HCC?

Risk-model mapping is not applicable to this nonbillable heading. Check a complete billable child code.

Source: CMS FY2027 ICD-10-CM order file. Read the FY2027 Official Guidelines.

Review the FY2026 April edition