Is ICD-10-CM code T61 billable?

No, T61 (Toxic effect of noxious substances eaten as seafood) is a non-billable ICD-10-CM code. It must be coded to a more specific subcategory before it can be used for reimbursement.

What chapter does ICD-10-CM code T61 belong to?

T61 belongs to Chapter 19 of the ICD-10-CM tabular list: S00–T88 (Injury, Poisoning and Certain Other Consequences of External Causes).

T61Not billable, use a more specific code below

Toxic effect of noxious substances eaten as seafood

In Toxic effects of substances chiefly nonmedicinal as to source (T51-T65), chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes

72 billable codes under T61: none are a CC or MCC; 6 map to HCC 155 (Major Depression, Moderate or Severe, without Psychosis).An HCC counts toward a Medicare Advantage patient's risk score.

Instructional notes

Excludes1: not coded here, use a different code

allergic reaction to food, such as:
anaphylactic reaction or shock due to adverse food reaction (T78.0-)
bacterial foodborne intoxications (A05.-)
dermatitis (L23.6, L25.4, L27.2)
food protein-induced enterocolitis syndrome (K52.21)
food protein-induced enteropathy (K52.22)
gastroenteritis (noninfective) (K52.29)
toxic effect of aflatoxin and other mycotoxins (T64)
toxic effect of cyanides (T65.0-)
toxic effect of harmful algae bloom (T65.82-)
toxic effect of hydrogen cyanide (T57.3-)
toxic effect of mercury (T56.1-)
toxic effect of red tide (T65.82-)

Also applies, from Toxic effects of substances chiefly nonmedicinal as to source (T51-T65)

These notes sit on T51-T65 and apply to every code under it, including T61.

Excludes1: not coded here, use a different code

contact with and (suspected) exposure to toxic substances (Z77.-)

Use additional code: add a second code for this, listed after this one

code(s):
for all associated manifestations of toxic effect, such as: respiratory conditions due to external agents (J60-J70)
personal history of foreign body fully removed (Z87.821)
to identify any retained foreign body, if applicable (Z18.-)

Official coding guidelines

From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.

Section I.C.19.e Adverse Effects, Poisoning, Underdosing and Toxic Effects (page 82), covers T61
For adverse effects, code the effect first, then T36-T50 with character 5. Sequence poisonings (unknown intent coded accidental) and toxic effects (T51-T65) first; underdosing (character 6) is never first-listed.

All codes under T61

T61 can't be used on a claim. Pick a billable code below; grey headings group them.

T61 MS-DRGs

As the principal diagnosis, the billable codes under T61 group to MS-DRG 917, 918, 922, 923, 949, or 950 (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

DRG 917 Poisoning and Toxic Effects of Drugs with MCC (24 of 72 codes)
DRG 918 Poisoning and Toxic Effects of Drugs without MCC (24 of 72 codes)
DRG 922 Other Injury, Poisoning and Toxic Effect Diagnoses with MCC (24 of 72 codes)
DRG 923 Other Injury, Poisoning and Toxic Effect Diagnoses without MCC (24 of 72 codes)
DRG 949 Aftercare with CC/MCC (24 of 72 codes)
DRG 950 Aftercare without CC/MCC (24 of 72 codes)

Other codes that refer to T61

Notes on these codes point to T61.

A05 Excludes1: toxic effect of noxious foodstuffs (T61-T62)
T63 Excludes2: ingestion of toxic animal or plant (T61.-, T62.-)
T63.5 Excludes2: poisoning by ingestion of fish (T61.-)

About the condition

Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.

Foodborne Illness

Each year, around 48 million people in the United States get sick from contaminated food. Common causes include bacteria and viruses. Less often, the cause may be a parasite or a harmful chemical, such as a high amount of pesticides. Symptoms of foodborne illness depend on the cause. They can be mild or serious. They usually include:

Code history

Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.