T38.805S — Adverse effect of unspecified hormones and synthetic substitutes, sequela
Is T38.805S billable?
Yes, but T38.805S is an unspecified code. T38.805S is a valid, billable ICD-10-CM code for encounters from October 1, 2026 through September 30, 2027. However, T38.805S is an unspecified or catch-all code. Payers apply additional scrutiny to unspecified codes and many deny them when the medical record supports a more specific option, so check the documentation before selecting T38.805S.
T38.805S at a glance
| Code | T38.805S |
|---|---|
| Description | Adverse effect of unspecified hormones and synthetic substitutes, sequela |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
| 7th character "S" | sequela |
What does the 7th character "S" mean in T38.805S?
In T38.805S, the 7th character S means sequela. The 7th character is required for T38.805S to be a valid, complete code.
Same condition, different episode of care — switch the 7th character:
What Medicare edits apply to T38.805S?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name T38.805S directly.
CMS will reject this code as the principal diagnosis on an inpatient claim. It describes something other than the condition chiefly responsible for the admission.
Which MS-DRGs does T38.805S group to?
T38.805S sits in MDC 21 and helps define the logic of 2 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 922Other Injury, Poisoning and Toxic Effect Diagnoses with MCCmedical
- 923Other Injury, Poisoning and Toxic Effect Diagnoses without MCCmedical
Excludes1 — never code together — inherited from T36-T50
The conditions below can never be reported together with T38.805S on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
- toxic reaction to local anesthesia in pregnancy (O29.3-)
Excludes1 — never code together — inherited from T38
The conditions below can never be reported together with T38.805S on the same claim. An Excludes1 note means the two conditions cannot occur in the same patient, so reporting both is a coding error.
Code first — inherited from T36-T50
The underlying condition below must be sequenced before T38.805S. T38.805S describes a manifestation and cannot be the principal or first-listed diagnosis.
Use additional code — inherited from Chapter 19
Report an additional code alongside T38.805S to fully describe the condition. T38.805S is sequenced first.
- code to identify any retained foreign body, if applicable (Z18.-)
Use additional code — inherited from T36-T50
Report an additional code alongside T38.805S to fully describe the condition. T38.805S is sequenced first.
Excludes2 — not included here — inherited from Chapter 19
The conditions below are not part of T38.805S, but a patient may have both at the same time. When documentation supports it, T38.805S and the excluded code may both be reported.
Excludes2 — not included here — inherited from T36-T50
The conditions below are not part of T38.805S, but a patient may have both at the same time. When documentation supports it, T38.805S and the excluded code may both be reported.
How long has T38.805S existed?
T38.805S has been in ICD-10-CM since at least FY2016, the earliest fiscal year on record here.
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.