ICD-10 Coding for Hamstring Tear(S76.311A, S76.312A)
Complete ICD-10-CM coding and documentation guide for Hamstring Tear. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Hamstring Tear
S76.3XXPrimary Range
Injury of muscle, fascia and tendon at thigh level
This range includes codes for traumatic injuries to the hamstring muscles, which are common in sports and physical activities.
Spontaneous rupture of other tendons, thigh
This range is used for nontraumatic, spontaneous ruptures of tendons in the thigh, which are less common than traumatic 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 the posterior muscle group at thigh level, right thigh, initial encounter | Use for initial encounters of acute hamstring tears in the right thigh. |
|
| S76.312A | Strain of muscle, fascia and tendon of the posterior muscle group at thigh level, left thigh, initial encounter | Use for initial encounters of acute hamstring tears in the left thigh. |
|
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 tear
Essential facts and insights about Hamstring Tear
Primary ICD-10-CM Codes for hamstring tear
Decision Criteria
clinical Criteria
- Presence of acute pain and MRI confirmation of tear
coding Criteria
- Initial encounter for right thigh injury
Applicable To
- Acute hamstring tear
- Right thigh muscle strain
Excludes
- Spontaneous rupture of tendon (M66.85-)
Clinical Validation Requirements
- MRI showing tear in the right posterior thigh muscle
- Physical exam indicating acute pain and limited range of motion
Code-Specific Risks
- Misidentifying laterality
- Incorrect encounter type
Coding Notes
- Ensure documentation specifies the exact muscle involved and the encounter type.
S76.312A - Strain of muscle, fascia and tendon of the posterior muscle group at thigh level, left thigh, initial encounter
Use for initial encounters of acute hamstring tears in the left thigh.
Applicable To
- Acute hamstring tear
- Left thigh muscle strain
Excludes
- Spontaneous rupture of tendon (M66.85-)
Clinical Validation Requirements
- MRI showing tear in the left posterior thigh muscle
- Physical exam indicating acute pain and limited range of motion
Coding Notes
Ensure documentation specifies the exact muscle involved and the encounter type.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Activity, sports
Y93.44Differential 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 Tear to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S76.311A.
Impact
Clinical: Incomplete clinical picture of the injury., Regulatory: Non-compliance with coding guidelines., Financial: Potential for denied claims.
Mitigation Strategy
Always include external cause codes when applicable., Review clinical documentation for activity details.
Impact
Reimbursement: Incorrect coding can lead to denied claims., Compliance: Non-compliance with coding standards., Data Quality: Inaccurate patient records.
Mitigation Strategy
Verify the side of the injury from the clinical documentation before coding.
Impact
Using initial encounter codes for follow-up visits.
Mitigation Strategy
Verify encounter type from clinical notes before coding.
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 Tear, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Hamstring Tear
Use these documentation templates to ensure complete and accurate documentation for Hamstring Tear. These templates include all required elements for proper coding and billing.
Initial Evaluation of Hamstring Tear
Specialty: OrthopedicsRequired Elements
- Patient history
- Physical examination findings
- Imaging results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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