HCPCS code G0268: Billing, reimbursement, and documentation guide
HCPCS code G0268 is a Level II G-code maintained by the Centers for Medicare and...
Last Updated: August 10, 2026
Key takeaways
T38.802D is a billable ICD-10-CM code for poisoning by unspecified hormones and synthetic substitutes, intentional self-harm, subsequent encounter.
The 7th character D means active treatment has already been given, so use A for the first encounter and S for sequela.
Documentation must confirm both the intentional self-harm intent and the subsequent encounter status.
Unspecified means the record does not identify which hormone was involved, not that the note was written poorly.
Practice management software like Pabau submits and tracks claims built from the patient record, while coders still choose the code.
ICD-10 code T38.802D is a billable ICD-10-CM diagnosis code for poisoning by unspecified hormones and synthetic substitutes. The intent recorded is intentional self-harm, and the encounter is a subsequent one.
Two elements decide whether the code holds up. One is the intent column in the Table of Drugs and Chemicals, and the other is the encounter type behind the 7th character. This reference covers the official descriptor, 7th character selection, code hierarchy, documentation requirements, and 2026 validity.
ICD-10 code T38.802D: definition and billable status
T38.802D is a billable, specific ICD-10-CM code valid for HIPAA-covered transactions. It represents poisoning by unspecified hormones and synthetic substitutes, intentional self-harm, subsequent encounter. The 2026 edition took effect on October 1, 2025, per the CMS ICD-10 guidance.
The code sits in Chapter 19 of the ICD-10-CM Tabular List, which covers injury, poisoning and certain other consequences of external causes (S00-T88). Because it is fully specified, it can go on a claim without a more granular code.
Where the code sits in the ICD-10-CM hierarchy
Knowing where T38.802D sits in the Tabular List helps you find sibling codes and follow the classification logic. The breadcrumb runs from chapter level down to the specific code:
- S00-T88 – Injury, poisoning and certain other consequences of external causes
- T36-T50 – Poisoning by, adverse effect of and underdosing of drugs, medicaments and biological substances
- T38 – Poisoning by, adverse effect of and underdosing of hormones and their synthetic substitutes and antagonists, not elsewhere classified
- T38.8 – Poisoning by, adverse effect of and underdosing of other and unspecified hormones and synthetic substitutes
- T38.80 – Poisoning by, adverse effect of and underdosing of unspecified hormones and synthetic substitutes
- T38.802 – Poisoning by unspecified hormones and synthetic substitutes, intentional self-harm
- T38.802D – Poisoning by unspecified hormones and synthetic substitutes, intentional self-harm, subsequent encounter
The CDC ICD-10-CM tool lets you walk this hierarchy and confirm the valid code for any given year. T38 excludes hormones classified elsewhere, so check the Alphabetic Index first to confirm the substance belongs in T38.
The 7th character: A, D, and S encounter types
The 7th character is mandatory on every T38 poisoning code. It records the encounter type and changes with each visit, so the character used at the first encounter does not carry over. The same A/D/S pattern runs through other Chapter 19 codes, including toxic-effect codes like T63.064D.
The ICD-10-CM Official Guidelines (Section I.C.19) define a subsequent encounter as any visit after active treatment for the condition. That covers outpatient follow-up, medication monitoring, and psychiatric or crisis follow-up billed with codes such as H0025. The D character does not mean the patient has recovered, only that the acute treatment phase is over.
What “unspecified” means in T38.802D
Unspecified is a coding qualifier, not a documentation shortcut. It means the record does not identify which hormone or synthetic substitute caused the poisoning. That reflects information nobody had at the time of care, rather than a note written carelessly.
When the specific hormone is documented, a more precise T38 code applies. Insulin and oral antidiabetic drugs sit at T38.3-, thyroid hormones at T38.1-, and glucocorticoids at T38.0-. Use T38.802D only when the record cannot identify the substance.
The AAPC ICD-10-CM code lookup lets you browse the T38 siblings and confirm the most specific code available before you fall back on unspecified.
Poisoning vs adverse effect vs underdosing
T38.802D is a poisoning code. Poisoning, adverse effect, and underdosing are easy to mix up. The intent column in the ICD-10-CM Table of Drugs and Chemicals settles the distinction.
Look up the substance in the Table of Drugs and Chemicals, or use the hormones, unspecified row when the drug is unknown. Then pick the intent column: accidental, intentional self-harm, assault, or undetermined.
T38.802D applies only when the record confirms intentional self-harm. An adverse effect of a correctly taken medicine takes its own code, as with T43.215A.
Clinical documentation requirements for T38.802D
Two elements must be in the record before T38.802D can be assigned: documented intentional self-harm intent, and evidence that this is a subsequent encounter. Without both, the code is unsupported.
- Intentional self-harm intent: The treating clinician must document that the poisoning was intentional and self-directed. This can appear in the history of present illness, a psychiatric assessment, or nursing notes. A structured suicide prevention worksheet gives that assessment a consistent home in the chart.
- Substance identification: Record whatever substance information exists. If the specific hormone cannot be identified, say so in the note. That confirms the unspecified qualifier is clinically appropriate.
- Encounter type: The record must show that active treatment was already provided at an earlier visit. Progress notes, referral letters, or a discharge summary from the initial encounter are the usual evidence. Clinical documentation tools and structured digital intake forms help capture these details at every visit.
- External cause codes: ICD-10-CM allows an external cause code alongside a poisoning code, and some payers require one. It records how and where the poisoning happened. Payer rules vary, so check each one.
- Additional codes: Code any manifestation of the poisoning as an additional diagnosis. Altered consciousness or endocrine disruption caused by the poisoning is coded separately, after T38.802D.
If your practice already runs HIPAA-compliant billing workflows, line the documentation capture policies up with these requirements. Review them with a certified coder or compliance officer before you rely on them.
Coding guidelines that apply to this code
The ICD-10-CM Official Guidelines for Coding and Reporting govern how T38.802D is assigned. They are approved by the four Cooperating Parties, and Section I.C.19 covers injuries, poisonings, and external causes. These rules and Tabular List instructions apply:
- Sequencing: When the poisoning is the reason for the encounter, sequence T38.802D first. Codes for any manifestations follow it.
- Do not code the adverse effect separately: When you assign a poisoning code, do not also assign an adverse effect code for the same substance. The poisoning code already captures the event.
- External cause coding: Add an external cause code from Chapter 20 to show how the event happened. For self-poisoning by drugs, the intent codes sit in the X60-X69 range. X64 covers other and unspecified drugs, medicaments and biological substances.
- Excludes1 note: The Tabular List entry for T38 carries an Excludes1 note. It covers oxytocic hormones (T48.0-), mineralocorticoids and their antagonists (T50.0-), and parathyroid hormones and derivatives (T50.9-). Excludes1 is a Tabular List instruction rather than Guidelines text, and it means those substances are never coded to T38.
- Placeholder characters: A placeholder X fills an empty position when a code needs a 7th character but has fewer than six. T38.802 already has six characters, so D lands in the seventh position without one.
Related and sibling codes within the T38 family
The T38.802 stem shares the T38 category with codes for other hormone poisoning scenarios. Checking the siblings first tells you whether a more specific code applies. Practices running mental health EMR or psychiatry EMR software see these encounters most often, usually as crisis presentations.
Is T38.802D valid for 2026?
Yes. T38.802D is valid for the 2026 ICD-10-CM edition, effective October 1, 2025. The 2026 update cycle changed neither the descriptor nor the billable status.
ICD-10-CM is updated every year by NCHS and CMS, and each edition takes effect on October 1. Check the code each fiscal year, because a code valid one year can be revised, split, or retired in the next.
How Pabau keeps documentation and claim submission connected
Coding a subsequent encounter well depends on what the earlier visit left behind. When intent, substance detail, and treatment history sit in free-text notes across different systems, the coder has to reconstruct them before the claim goes out.
Practice management software like Pabau keeps encounter type, intent qualifiers, and substance detail in structured fields on the patient record. Its claims management software pulls that recorded data into a pre-filled claim, then tracks the claim and records the payment.
Pabau does not choose the code for you. Coders still read the record and pick the intent column and the 7th character. What the practice management platform removes is the hunt for documentation that should have been captured at the last visit.
Keep coding documentation in one place
Pabau keeps encounter type, intent, and substance detail in structured fields on the patient record, then submits and tracks the claim built from it. Your coders still choose the code.
Conclusion
Both decisions behind T38.802D happen in the chart. If the note names intentional self-harm and shows that active treatment already happened, the code holds. If either element is missing, a less specific code is the honest choice.
So the practical move is to fix the first encounter. When the initial visit captures intent and substance detail properly, the follow-up encounter almost codes itself. Book a demo to see how Pabau keeps that documentation with the claim it supports.
Continue your research
Need a structured way to document a psychiatric assessment? Psychiatric evaluation template sets out the sections that capture intent, risk, and clinical history.
Writing notes that hold up in an audit? Safer clinical notes covers the documentation habits that keep a coded encounter defensible.
Following up after a self-harm presentation? Suicide safety plan gives you a structure for the plan you agree with the patient.
Billing crisis work alongside the diagnosis? CPT code 90839 explains how psychotherapy for crisis is timed and reported.
Frequently asked questions
What is ICD-10 code T38.802D used for?
T38.802D reports poisoning by unspecified hormones and synthetic substitutes with intentional self-harm intent. The encounter is a subsequent one, so active treatment was already given at an earlier visit.
Is T38.802D a billable ICD-10-CM code?
Yes. T38.802D is a billable, specific code valid for HIPAA-covered transactions. It took effect on October 1, 2025 with the 2026 ICD-10-CM edition and needs no more granular code.
What is the difference between T38.802A and T38.802D?
T38.802A covers the initial encounter, the first visit where the patient receives active treatment. T38.802D covers subsequent encounters, usually outpatient follow-up after the acute treatment phase ends.
What does the 7th character D mean in ICD-10 poisoning codes?
D marks a subsequent encounter, meaning active treatment has already been provided. Use it for routine follow-up and monitoring visits after the initial treatment is complete.
What is the difference between poisoning and adverse effect in ICD-10-CM?
Poisoning applies when a drug is taken incorrectly, in excess, by the wrong person, or with intent to harm. Adverse effect applies when a correctly administered drug causes a negative reaction.
How do I find T38.802D in the Table of Drugs and Chemicals?
Look up the hormone in the Table of Drugs and Chemicals, or use the hormones, unspecified row when the drug is unknown. Then read across to the intentional self-harm column and add the 7th character for the encounter type.
