ICD-10 Coding for Hamstring Muscle Strain(S76.312A)
Complete ICD-10-CM coding and documentation guide for Hamstring Muscle Strain. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Hamstring Muscle Strain
S76.31Primary Range
Strain of muscle, fascia and tendon of posterior muscle group at thigh level
This range includes codes for strains of the posterior thigh muscle group, which is the primary location for hamstring injuries.
Key Information: ICD-10 code for hamstring muscle strain
Essential facts and insights about Hamstring Muscle Strain
Primary ICD-10-CM Code for hamstring muscle strain
Decision Criteria
clinical Criteria
- Presence of acute pain and tenderness in the posterior thigh
coding Criteria
- Initial encounter for acute injury
documentation Criteria
- Detailed description of the injury mechanism and muscle group
Applicable To
- Acute hamstring strain
Excludes
- Chronic hamstring strain (M62.8)
Clinical Validation Requirements
- MRI showing edema in the posterior thigh
- Physical exam indicating tenderness and reduced range of motion
Code-Specific Risks
- Ensure laterality is specified
- Use correct 7th character for encounter type
Coding Notes
- Ensure documentation includes the specific muscle group involved and the mechanism of injury.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Activity, American football
Y93.64Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Hamstring Muscle Strain to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code S76.312A.
Impact
Clinical: Inaccurate patient records., Regulatory: Non-compliance with coding standards., Financial: Potential claim denials.
Mitigation Strategy
Always specify laterality and encounter type., Use detailed clinical documentation.
Impact
Reimbursement: Claims may be denied or delayed due to lack of specificity., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate data collection affecting patient records.
Mitigation Strategy
Always specify whether the injury is on the left or right side.
Impact
Lack of specificity in documentation can lead to audit flags.
Mitigation Strategy
Ensure all documentation includes specific details about the injury, including laterality and encounter type.
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 Muscle Strain, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Hamstring Muscle Strain
Use these documentation templates to ensure complete and accurate documentation for Hamstring Muscle Strain. These templates include all required elements for proper coding and billing.
Initial Evaluation of Hamstring Strain
Specialty: Sports MedicineRequired Elements
- History of present illness
- Physical examination findings
- Imaging results
- Diagnosis
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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