ICD code T44.6X3D – Alpha-blocker poisoning by assault, follow-up visit

Key takeaways

T44.6X3D is a valid, billable ICD-10-CM code for alpha-adrenoreceptor antagonist poisoning by assault at a subsequent (follow-up) encounter.

The 6th character 3 means assault, so the record must document that another person caused the poisoning.

The 7th character D means the patient is in the routine-care phase after the poisoning, not the active-treatment phase (which takes A).

Code any manifestation still present, such as drug-induced hypotension (I95.2) or syncope, after T44.6X3D per guideline I.C.19.e.5(b).

When abuse is documented as confirmed, guideline I.C.19.f sequences the T74 code first, ahead of T44.6X3D.

ICD-10 code T44.6X3D covers alpha-blocker poisoning by assault at follow-up

ICD-10 code T44.6X3D reports poisoning by an alpha-adrenoreceptor antagonist that another person inflicted, coded at a follow-up visit after active treatment has ended. It’s a 7-character, billable code for inpatient and outpatient claims. It has been valid since FY2016 and is active in the current fiscal year.

Each of the seven characters in T44.6X3D carries meaning

Read the code left to right and it tells the whole story: the drug class, the intent and the stage of care. Change any one character and you’ve reported a different code, with different documentation behind it.

The placeholder X at position 5 is required by ICD-10-CM structure. Without it, the code is only six characters and won’t pass as a valid billable code. A coder who drops the X triggers a claim edit on submission.

The named drug decides whether T44.6 fits

T44.6 covers drugs classified as alpha-adrenoreceptor antagonists (alpha blockers) in the ICD-10-CM Table of Drugs and Chemicals. The specific drug must appear in the patient’s record, because “alpha blocker” alone does not support the code.

• Tamsulosin (Flomax): Alpha-1 selective, most commonly prescribed for benign prostatic hyperplasia (BPH)
• Doxazosin (Cardura): Alpha-1 selective, used for BPH and hypertension, with a long half-life that can prolong overdose effects
• Prazosin (Minipress): Alpha-1 selective, used for hypertension and, off-label, for PTSD-related nightmares
• Terazosin (Hytrin): Alpha-1 selective, used for BPH and hypertension, with a known risk of first-dose hypotension
• Alfuzosin: Alpha-1 selective, prescribed for BPH
• Silodosin: Highly selective for the alpha-1A subtype, prescribed for BPH

All of these drugs route to T44.6 in the Table of Drugs and Chemicals. When the documented drug isn’t on this list, check its row in the table before assigning T44.6X3D.

The 6th character 3 needs documented assault

The 6th character 3 in T44.6X3D means assault. Another person caused the poisoning, for example by giving the patient an alpha blocker without their knowledge or forcing an ingestion. The record must document that someone else was responsible.

That documentation is usually the provider’s note of the patient’s or a witness’s account, or a confirmed finding of maltreatment. A suspicion alone does not support 3. When abuse is documented as confirmed, I.C.19.f sequences the T74 code first, ahead of T44.6X3D.

Assault is also easy to confuse with its neighbor. The 6th character 4 means undetermined intent (T44.6X4D), and it isn’t a safe default. Per Section I.C.19.e.5(b), unknown or unspecified intent is coded as accidental (T44.6X1D). Undetermined applies only when the record states that intent cannot be determined.

The 7th character D marks routine care after treatment

The 7th character D designates a subsequent encounter. The patient has completed active treatment for the poisoning and now receives routine care during the healing or recovery phase. Typical visits are blood pressure monitoring, medication adjustments, or follow-up lab review.

The most common error here is using D for an emergency department visit or an inpatient admission where active treatment is still occurring. That scenario requires 7th character A. Use A while the provider is still managing the acute toxic effect. Use D once the patient is stable and returning for a check.

Put intent, stage of care and sequencing together and you get three questions to answer, in this order, before the code goes on the claim.

Poisoning, adverse effect and underdosing sequence differently

The T44.6 family covers three different drug-related scenarios, each with its own code range and sequencing rule. Pick the wrong one and you change both the order of the codes and what else the claim needs.

Poisoning and adverse effect run in opposite orders. For a poisoning, the T code comes first and the manifestation follows, unless a T74 code applies.

For an adverse effect, the manifestation (hypotension, syncope) leads and the T44.6X5- code follows. A patient who took less of the drug than prescribed belongs under underdosing instead, starting with T44.6X6A at the first visit.

T44.6X3D is one of 18 codes in its family

T44.6X3D sits inside a family of 18 codes covering every combination of intent and encounter type for alpha-adrenoreceptor antagonist exposures. Knowing the full family keeps you from landing on a sibling code by accident.

The same 7th character logic applies across the T36-T50 drug range: A for active treatment, D for routine care, S for late effects. Neighboring categories T44.5 (predominantly beta-adrenoreceptor agonists) and T44.7 (beta-adrenoreceptor antagonists) follow identical structural patterns.

Companion codes T44.6X3D needs on the claim

Section I.C.19.e.5(b) of the ICD-10-CM guidelines instructs coders to use additional codes for all manifestations of a poisoning. At a follow-up visit, code the manifestations the provider still documents and treats.

Per the ICD-10-CM Official Guidelines, the poisoning code (T44.6X3D) sequences first as the principal or first-listed diagnosis, unless a T74 code applies. Manifestation codes follow.

• Hypotension, including orthostatic hypotension caused by the drug: I95.2 (hypotension due to drugs)
• Syncope or near-syncope: R55
• Dizziness/vertigo: R42
• Tachycardia: R00.0
• External cause codes: Place of occurrence (Y92) is generally reported once, at the initial encounter, so do not repeat it with T44.6X3D. Activity (Y93) and status (Y99) codes do not apply to poisonings.

No separate external cause code is needed for intent, because the 6th character of T44.6X3D already reports assault.

A worked example shows how the claim moves

Rules are easier to apply once you’ve seen them on one patient. Here’s how a typical T44.6X3D claim travels from the first visit to the follow-up bill. If the steps between a visit and a payment are new to your team, what is medical billing covers the basics.

1. The initial visit: A coworker crushed doxazosin into the patient’s coffee. The emergency department treated the low blood pressure and reported T44.6X3A with a Y92 place code.
2. The follow-up note: Two weeks later, the patient sees their primary care provider. Blood pressure still drops on standing, and the provider documents orthostatic hypotension caused by the doxazosin.
3. Code assignment: Active treatment has ended, so the 7th character is D. The coder lists T44.6X3D first and I95.2 second, with no Y92 code.
4. Submission: The claim goes to the payer with the visit’s procedure code, the two diagnosis codes and the note behind them.
5. Adjudication: The payer checks that the codes are valid and consistent with each other. If it rejects the claim, recheck step 3 first.

Change one fact and the claim changes with it. If the note had confirmed abuse, a T74 code would lead. If the patient were still on IV fluids, the code would be T44.6X3A.

The note has to prove four facts for T44.6X3D

Alpha-adrenoreceptor antagonist poisoning produces predictable cardiovascular effects. Expect hypotension (often orthostatic), reflex tachycardia, and dizziness or syncope. To support T44.6X3D, the medical record must establish four facts.

1. The specific drug involved: “Alpha blocker” is insufficient. The note must name tamsulosin, doxazosin, prazosin, or whichever agent is involved.
2. That the poisoning was an assault: The note should record that another person caused the exposure, for example from the patient’s or a witness’s account. If intent is not documented at all, the guideline default is accidental (T44.6X1D).
3. That this is a follow-up visit: The note should show that the acute phase has resolved. The patient is back for monitoring or medication review.
4. Clinical manifestations present: Hypotension, dizziness, syncope, or other toxic effects should be documented to support the companion codes required under Section I.C.19.e.5(b).

The assault account usually lives in the emergency note, while the follow-up is billed weeks later from a different chart. When the two records aren’t linked, the coder has to hunt for intent before assigning a single character.

The medical billing compliance guide covers how to keep that trail audit-ready.

Six errors get T44.6X3D claims denied

Errors on T44.6X3D claims tend to fall into six patterns, and each one is preventable. When one slips through, it returns as a code on the remittance advice, which the guide to medical billing denial codes helps you read.

1. Using D when the encounter was initial (A): An ED visit for an acute alpha-blocker ingestion is not a subsequent encounter. Submitting T44.6X3D instead of T44.6X3A on an acute-care claim generates a clinical inconsistency edit.
2. Missing manifestation codes: When the note documents ongoing hypotension, syncope, or dizziness, leaving those codes off falls short of Section I.C.19.e.5(b). Review denial patterns for this with denial management guidance.
3. Coding assault without documentation that supports it: A suspicion of foul play is not enough for T44.6X3D. An accidental ingestion, such as a medication mix-up, takes T44.6X1D, and unknown intent defaults to accidental.
4. Swapping the 3 and the 4: The 6th character 3 is assault and 4 is undetermined. Reporting T44.6X3D for a poisoning of undetermined intent misstates the case, and the correct code is T44.6X4D.
5. Submitting T44.6X3 (6-character) instead of T44.6X3D (7-character): The 6-character subcategory is not billable, so a claim without the 7th character is rejected.
6. Repeating the place-of-occurrence code: Place of occurrence (Y92) is generally reported once, at the initial encounter, so do not repeat it with T44.6X3D. A clean claim checklist should catch it on a follow-up claim.

Run this checklist before you submit the claim

Those six errors come down to a short pre-submission check. Run it at charge entry, while the note is still open in front of you.

• The note names the drug, and the Table of Drugs and Chemicals routes it to T44.6.
• The note records that another person caused the poisoning.
• Active treatment has ended, so D fits rather than A.
• Confirmed abuse puts the T74 code first. Otherwise, T44.6X3D is first-listed.
• Each manifestation still being treated is coded after the poisoning code.
• The code has all seven characters, with the X placeholder in position 5.
• No Y92 place code is repeated, and no Y93 or Y99 code is added.

Payers accept T44.6X3D in both settings

T44.6X3D is valid for both inpatient and outpatient billing under Medicare, Medicaid, and commercial payers. The Centers for Medicare and Medicaid Services (CMS ICD-10 codes page) publishes the annual fiscal-year code files that confirm it remains valid.

Section I.C.19.e of the ICD-10-CM Official Guidelines for Coding and Reporting governs sequencing for all T44 poisoning codes. These are the compliance points that matter for T44.6X3D.

• Inpatient principal diagnosis: The Uniform Hospital Discharge Data Set (UHDDS) rules apply. T44.6X3D is the principal diagnosis when the poisoning is the condition chiefly responsible for admission, unless a T74 code applies.
• Outpatient first-listed diagnosis: T44.6X3D is the first-listed code, unless a T74 code applies, followed by manifestation codes. Outpatient guidelines don’t use the inpatient principal-diagnosis analysis, but the order is the same in practice.
• Prior authorization: The code assignment itself does not need authorization. Some payers do require it for an inpatient stay that a poisoning event triggers.
• Medical necessity: Documentation must support why the follow-up visit was necessary, such as ongoing blood pressure monitoring, medication review, or management of residual effects.

Poisoning claims are one small part of how a practice gets paid. Revenue cycle management shows where coding checks sit in that wider process.

ICD-9 records split this code into two parts

ICD-9-CM captured intent through separate E-codes, such as E962.0 for assault by drugs and medicinal substances. It had no character for encounter type, so no ICD-9 code separates a follow-up visit from the first one. The General Equivalence Mappings (GEMs) are approximate and are never used for current-year billing.

For historical record audits or cross-system reporting, the ResDAC guidance on ICD codes in Medicare files explains how GEMs crosswalk limits affect retrospective research. GEMs mappings carry no reimbursement guarantee. Always code active claims from the current-year tabular list.

Pabau keeps the assault note and the follow-up claim together

Follow-up poisoning claims often fail on context. The assault documentation sits in the emergency note, while the follow-up visit is billed weeks later from a different chart. The coder then has to piece the intent and the remaining symptoms back together.

Pabau, the practice management and billing platform we build, keeps the initial event and every follow-up in one patient record. Its claims management software pre-fills the claim from that record. Its ICD-10-CM lookup finds T44.6X3D and its companion codes without leaving the screen.

Pabau also checks that required claim fields are complete before the claim can be sent. US practices submit through Claim.MD, then track each claim’s status in the same place, so a denial reaches you while the note is still fresh.

Keep T44.6X3D claims clean from chart to payer

Pabau keeps the assault note and every follow-up in one record, then pre-fills the claim from it. US practices submit through Claim.MD and track each claim’s status in the same place.

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Conclusion

T44.6X3D is only correct when two facts are on the record. Another person caused the alpha-blocker poisoning, and the patient is back for routine care after active treatment. If the note can’t show the assault, the code is wrong, however clean the rest of the claim looks.

So settle intent before you touch the 7th character. Confirmed assault takes 3, a stated inability to determine intent takes 4, and silence on intent defaults to accidental. Then check for confirmed abuse, which moves a T74 code to the front, and code only the manifestations the provider still treats.

Keeping the assault note and the follow-up visit in one record makes that check quick. Book a demo to see how Pabau supports documentation and claim submission for poisoning follow-ups.

Continue your research

Need guidance on managing claim denials for ICD-10 poisoning codes? Denial management in healthcare covers systematic approaches to identifying, appealing, and preventing coding-related claim denials.

Want to understand how clean claim requirements apply to multi-code submissions? Clean claim standards explains the technical and coding requirements that define a payable claim across payer types.

Looking for the broader billing compliance framework? Medical billing compliance outlines documentation, coding, and audit-readiness practices for healthcare practices of all sizes.

Coding a patient who took less of an alpha blocker than prescribed? ICD-10 code T44.6X6A explains the underdosing code, its sequencing and the documentation it needs.

Billing the inpatient stay that came before the follow-up? Inpatient billing cheat sheet puts principal-diagnosis rules and claim checks on one printable page.

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