ICD-10 Coding for Hamstring Pull(S76.311A, S76.01XA)
Complete ICD-10-CM coding and documentation guide for Hamstring Pull. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Hamstring Pull
S76.3Primary Range
Injury of muscle, fascia and tendon at thigh level
This range includes codes for strains of the posterior thigh muscle group, which are common in hamstring pulls.
Injury of muscle, fascia and tendon at hip level
This range is relevant for proximal hamstring injuries near the hip.
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 posterior thigh muscle group, right thigh, initial encounter | Use for acute hamstring strains of the right thigh during initial encounter. |
|
| S76.01XA | Strain of muscle, fascia and tendon at hip level, initial encounter | Use for proximal hamstring injuries near the hip during initial encounter. |
|
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 pull
Essential facts and insights about Hamstring Pull
Primary ICD-10-CM Codes for hamstring pull
Decision Criteria
clinical Criteria
- Presence of acute posterior thigh pain and MRI confirmation of muscle tear.
Applicable To
- Acute hamstring strain
- Grade 1-3 hamstring strain
Excludes
- Chronic hamstring tendinopathy
Clinical Validation Requirements
- MRI showing muscle tear
- Physical exam with tenderness and pain on resisted knee flexion
Code-Specific Risks
- Confusion with hip strain codes
- Incorrect laterality documentation
Coding Notes
- Ensure documentation specifies laterality and encounter type.
S76.01XA - Strain of muscle, fascia and tendon at hip level, initial encounter
Use for proximal hamstring injuries near the hip during initial encounter.
Applicable To
- Proximal hamstring strain
Excludes
- Thigh muscle strains
Clinical Validation Requirements
- MRI showing proximal muscle involvement
- Pain localized to the hip area
Coding Notes
Differentiate between hip and thigh strains based on location.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Hamstring Pull 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 plans., Regulatory: Non-compliance with documentation standards., Financial: Potential for denied claims due to lack of specificity.
Mitigation Strategy
Train staff on the importance of detailed documentation., Use templates that prompt for specific details.
Impact
Reimbursement: May lead to denied claims or reduced reimbursement., Compliance: Non-compliance with coding specificity requirements., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Ensure documentation specifies right or left side to use S76.311A or S76.312A.
Impact
Risk of audits due to use of unspecified codes.
Mitigation Strategy
Implement regular training on documentation specificity.
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 Pull, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Hamstring Pull
Use these documentation templates to ensure complete and accurate documentation for Hamstring Pull. These templates include all required elements for proper coding and billing.
Acute Hamstring Strain
Specialty: Sports MedicineRequired Elements
- Patient history of injury
- Physical exam findings
- Imaging results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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