ICD-10 Coding for Hamstring Injury(S76.311A, S76.301A)
Complete ICD-10-CM coding and documentation guide for Hamstring Injury. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Hamstring Injury
S76.3Primary Range
Injury of muscle, fascia and tendon of posterior muscle group at thigh level
This range covers all injuries to the hamstring muscles, including strains and tears.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| S76.311A | Strain of muscle, fascia and tendon of right semitendinosus muscle, initial encounter | Use for initial encounter of a confirmed right semitendinosus tear. |
|
| S76.301A | Unspecified injury of muscle, fascia and tendon of right thigh, initial encounter | Use when the specific muscle or injury type is not documented. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for hamstring injury
Essential facts and insights about Hamstring Injury
Primary ICD-10-CM Codes for hamstring injury
Decision Criteria
clinical Criteria
- MRI shows tear of right semitendinosus
documentation Criteria
- Documented as initial encounter
Applicable To
- Complete tear of right semitendinosus
Excludes
- Chronic tendinopathy
Clinical Validation Requirements
- MRI confirming tear
- Clinical exam showing weakness and pain
Code-Specific Risks
- Incorrect laterality
- Missing 7th character
Coding Notes
- Ensure documentation specifies the muscle involved and encounter type.
S76.301A - Unspecified injury of muscle, fascia and tendon of right thigh, initial encounter
Use when the specific muscle or injury type is not documented.
Applicable To
- Unspecified hamstring injury
Excludes
- Specific muscle tears
Clinical Validation Requirements
- Lack of specific imaging or clinical details
Coding Notes
Encourage detailed documentation to avoid unspecified codes.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Muscle weakness
M62.81Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Hamstring Injury to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S76.311A.
Impact
Clinical: May lead to incorrect treatment categorization., Regulatory: Non-compliance with coding standards., Financial: Potential for denied claims.
Mitigation Strategy
Always verify the encounter type before coding.
Impact
Reimbursement: May lead to lower reimbursement rates., Compliance: Increases risk of audit., Data Quality: Reduces accuracy of clinical data.
Mitigation Strategy
Ensure documentation includes specific muscle and injury type.
Impact
Unspecified codes increase audit risk.
Mitigation Strategy
Encourage detailed documentation to specify injury details.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Hamstring Injury, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Hamstring Injury
Use these documentation templates to ensure complete and accurate documentation for Hamstring Injury. These templates include all required elements for proper coding and billing.
Initial encounter for hamstring strain
Specialty: Sports MedicineRequired Elements
- Mechanism of injury
- Specific muscle involved
- Imaging results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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