With the use of semaglutide and tirzepatide going mainstream, it’s starting to create some real coding challenges. Coding Clinic, First Quarter 2026, addresses some of these issues – specifically around adverse effects and long-term use. At the center of it all is one key concept: you need to understand what type of drugs these are.

Not Your Typical Antidiabetic Medications

Semaglutide medications are glucagon-like peptide-1 (GLP-1) receptor agonists. These drugs mimic the natural GLP-1 hormone, helping to regulate blood sugar and reduce appetite. GLP-1s decrease appetite, slow gastric emptying, and improve insulin release.

Some of the most common semaglutide products include:

• • Ozempic (type 2 diabetes)
  • Wegovy (overweight/obesity)

Tirzepatide takes it a step further by combining a GLP-1 receptor with a glucose-dependent insulinotropic polypeptide (GIP) receptor. GIPs enhance insulin response and may improve fat metabolism. Because of this dual mechanism, tirzepatide is often associated with greater weight loss and improved glycemic control than a GLP-1 alone.

Common tirzepatide products include:

• • Mounjaro (type 2 diabetes mellitus)
  • Zepbound (overweight/obesity)

Now for the Coding Part

Here’s where things tend to go off track.

Even though these medications are frequently used to treat diabetes, they are not classified as antidiabetic agents in ICD-10-CM. Instead, they are classified as hormones and synthetic substitutes. That distinction matters.

Adverse Effects

When coding an adverse effect of semaglutide or tirzepatide, assign:

• • T38.895-, Adverse effect of other hormones and synthetic substitutes

Do not assign:

• • T38.3X5-, Adverse effect of insulin and oral hypoglycemic drugs

This is an easy mistake to make, and it comes down to misclassifying the drug type.

Long-Term Use

Coding long-term use presents a similar issue.

The correct code assignment is:

• • Z79.899, Other long term (current) drug therapy

Do not assign:

• • Z79.85, Long-term use of injectable non-insulin antidiabetic drugs

Again, the reason is the same: these medications are synthetic hormones, not traditional antidiabetic agents.

Final Thoughts

As these medications become more widely used, we’re going to continue to see issues like these arise. The key is to stay grounded in drug classification, not just clinical use.

And as always, reviewing Coding Clinic when it’s released is critical to staying current.

If you want a deeper dive into this topic and other updates from First Quarter Coding Clinic, be sure to check out our April webinar. We’ll walk through the latest guidance along with additional insights from Haugen audits and training.

And in the meantime, the next time you see Ozempic or Mounjaro in the record, just remember – don’t let the indication fool you. These may be used for diabetes, but in coding, they’re still hormones.