ICD-10 Coding for Hamstring Strain(S76.311A, S76.10XA)
Complete ICD-10-CM coding and documentation guide for Hamstring Strain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Hamstring Strain
S76.3XXPrimary Range
Strain of muscle, fascia, and tendon of posterior muscle group at thigh level
This range covers the primary codes for hamstring strains, specifically targeting the posterior muscle group.
Strain of muscle, fascia, and tendon of anterior muscle group at thigh level
This range is relevant for differential diagnosis when the strain involves the anterior thigh muscles.
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 posterior muscle group at thigh level, right thigh, initial encounter | Use for initial encounter of right posterior thigh muscle strain confirmed by clinical and imaging findings. |
|
| S76.10XA | Strain of unspecified muscle, fascia, and tendon at thigh level, initial encounter | Use when the strain cannot be localized to a specific muscle group. |
|
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 strain
Essential facts and insights about Hamstring Strain
Primary ICD-10-CM Codes for hamstring strain
Decision Criteria
clinical Criteria
- MRI shows muscle fiber disruption in the posterior thigh.
documentation Criteria
- Documented active knee extension deficit >15°.
Applicable To
- Acute strain of right hamstring
Excludes
- Tendon rupture (M66.851)
Clinical Validation Requirements
- MRI confirmation of muscle fiber disruption
- Active knee extension deficit >15°
Code-Specific Risks
- Incorrect laterality documentation
- Failure to specify encounter type
Coding Notes
- Ensure documentation includes specific muscle group and laterality.
S76.10XA - Strain of unspecified muscle, fascia, and tendon at thigh level, initial encounter
Use when the strain cannot be localized to a specific muscle group.
Excludes
- Specific muscle group strains (S76.3XX, S76.0XX)
Clinical Validation Requirements
- Clinical exam without specific localization
Coding Notes
Use only when specific muscle group cannot be determined.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Activity, soccer
Y93.67Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Spontaneous rupture of tendon, right thigh
M66.851Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Hamstring Strain 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 planning., Regulatory: Non-compliance with ICD-10 coding rules., Financial: Potential for denied claims due to lack of specificity.
Mitigation Strategy
Always include laterality in clinical notes, Use templates that prompt for laterality
Impact
Reimbursement: May lead to lower reimbursement due to lack of specificity., Compliance: Non-compliance with coding guidelines for specificity., Data Quality: Decreases accuracy of clinical data.
Mitigation Strategy
Query provider for specific muscle group involvement.
Impact
Audits may target lack of specificity in muscle group coding.
Mitigation Strategy
Ensure all documentation specifies the exact muscle group and laterality.
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 Strain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Hamstring Strain
Use these documentation templates to ensure complete and accurate documentation for Hamstring Strain. These templates include all required elements for proper coding and billing.
Acute hamstring strain during sports
Specialty: Sports MedicineRequired Elements
- Mechanism of injury
- Specific muscle group affected
- Objective findings (e.g., AKE test results)
- Imaging results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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