ICD-10-CM Code T76.11XS

Adult physical abuse, suspected, sequela

Version 2020 Replaced Code Billable Code Adult Diagnoses POA Exempt

Valid for Submission

T76.11XS is a billable code used to specify a medical diagnosis of adult physical abuse, suspected, sequela. The code is valid for the year 2020 for the submission of HIPAA-covered transactions. The ICD-10-CM code T76.11XS might also be used to specify conditions or terms like suspected elderly person maltreatment or suspected victim of adult abuse or suspected victim of elder physical abuse or suspected victim of physical abuse. The code is exempt from present on admission (POA) reporting for inpatient admissions to general acute care hospitals.

The code T76.11XS is applicable to adult patients aged 15 through 124 years inclusive. It is clinically and virtually impossible to use this code on a patient outside the stated age range.

ICD-10:T76.11XS
Short Description:Adult physical abuse, suspected, sequela
Long Description:Adult physical abuse, suspected, sequela

Replaced Code

This code was replaced in the 2020 ICD-10 code set with the code(s) listed below. The National Center for Health Statistics (NCHS) has published an update to the ICD-10-CM diagnosis codes which became effective October 1, 2019. This code was replaced for the FY 2020 (October 1, 2019 - September 30, 2020).

  • T76.61XS - Adult forced labor exploitation, suspected, sequela

Code Edits

The Medicare Code Editor (MCE) detects and reports errors in the coding of claims data. The following ICD-10 Code Edits are applicable to this code:

  • Adult diagnoses - Adult. Age range is 15–124 years inclusive (e.g., senile delirium, mature cataract).

Synonyms

The following clinical terms are approximate synonyms or lay terms that might be used to identify the correct diagnosis code:

  • Suspected elderly person maltreatment
  • Suspected victim of adult abuse
  • Suspected victim of elder physical abuse
  • Suspected victim of physical abuse

Diagnostic Related Groups

The ICD-10 code T76.11XS is grouped in the following groups for version MS-DRG V37.0 What are Diagnostic Related Groups?
The Diagnostic Related Groups (DRGs) are a patient classification scheme which provides a means of relating the type of patients a hospital treats. The DRGs divides all possible principal diagnoses into mutually exclusive principal diagnosis areas referred to as Major Diagnostic Categories (MDC).
applicable from 10/01/2019 through 09/30/2020.

  • 922 - OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC
  • 923 - OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC

Present on Admission (POA)

T76.11XS is exempt from POA reporting - The Present on Admission (POA) indicator is used for diagnosis codes included in claims involving inpatient admissions to general acute care hospitals. POA indicators must be reported to CMS on each claim to facilitate the grouping of diagnoses codes into the proper Diagnostic Related Groups (DRG). CMS publishes a listing of specific diagnosis codes that are exempt from the POA reporting requirement. Review other POA exempt codes here .

CMS POA Indicator Options and Definitions
POA Indicator CodePOA Reason for CodeCMS will pay the CC/MCC DRG?
YDiagnosis was present at time of inpatient admission.YES
NDiagnosis was not present at time of inpatient admission.NO
UDocumentation insufficient to determine if the condition was present at the time of inpatient admission.NO
WClinically undetermined - unable to clinically determine whether the condition was present at the time of inpatient admission.YES
1Unreported/Not used - Exempt from POA reporting. NO

Convert T76.11XS to ICD-9

  • 909.9 - Late eff exter cause NEC (Approximate Flag)

Code Classification

  • Injury, poisoning and certain other consequences of external causes (S00–T98)
    • Other and unspecified effects of external causes (T66-T78)
      • Adult and child abuse, neglect and oth maltreat, suspected (T76)

Code History

  • FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016
    (First year ICD-10-CM implemented into the HIPAA code set)
  • FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
  • FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
  • FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
  • FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020