2024 ICD-10-CM Diagnosis Code T76.21XS

Adult sexual abuse, suspected, sequela

ICD-10-CM Code:
T76.21XS
ICD-10 Code for:
Adult sexual abuse, suspected, sequela
Is Billable?
Yes - Valid for Submission
Chronic Condition Indicator: [1]
Not chronic
Code Navigator:

Code Classification

  • Injury, poisoning and certain other consequences of external causes
    (S00–T88)
    • Other and unspecified effects of external causes
      (T66-T78)
      • Adult and child abuse, neglect and other maltreatment, suspected
        (T76)

T76.21XS is a billable diagnosis code used to specify a medical diagnosis of adult sexual abuse, suspected, sequela. The code is valid during the current fiscal year for the submission of HIPAA-covered transactions from October 01, 2023 through September 30, 2024. The code is exempt from present on admission (POA) reporting for inpatient admissions to general acute care hospitals.

The code T76.21XS 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.

T76.21XS is a sequela code, includes a 7th character and should be used for complications that arise as a direct result of a condition like adult sexual abuse suspected. According to ICD-10-CM Guidelines a "sequela" code should be used for chronic or residual conditions that are complications of an initial acute disease, illness or injury. The most common sequela is pain. Usually, two diagnosis codes are needed when reporting sequela. The first code describes the nature of the sequela while the second code describes the sequela or late effect.

Approximate Synonyms

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

  • Alleged victim of sexual assault
  • Homicide and assault by fight, brawl and rape
  • Homicide or assault by rape
  • Suspected elderly person maltreatment
  • Suspected victim of abuse by intimate partner
  • Suspected victim of adult abuse
  • Suspected victim of adult abuse
  • Suspected victim of adult physical abuse
  • Suspected victim of adult physical abuse
  • Suspected victim of adult sexual abuse
  • Suspected victim of elder physical abuse
  • Suspected victim of elder sexual abuse
  • Suspected victim of sexual abuse
  • Suspected victim of sexual abuse
  • Suspected victim of sexual abuse by intimate partner
  • Suspected victim of sexual grooming

Clinical Classification

Coding Guidelines

The appropriate 7th character is to be added to each code from block Adult and child abuse, neglect and other maltreatment, suspected (T76). Use the following options for the aplicable episode of care:

  • A - initial encounter
  • D - subsequent encounter
  • S - sequela

Code Edits

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

  • Adult diagnoses - The Medicare Code Editor detects inconsistencies in adult cases by checking a patient's age and any diagnosis on the patient's record. The adult code edits apply to patients age range is 15–124 years inclusive (e.g., senile delirium, mature cataract).

Present on Admission (POA)

T76.21XS 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 IndicatorReason 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 T76.21XS to ICD-9-CM

  • ICD-9-CM Code: 909.9 - Late eff exter cause NEC
    Approximate Flag - The approximate mapping means there is not an exact match between the ICD-10 and ICD-9 codes and the mapped code is not a precise representation of the original code.

Patient Education


Sexual Assault

What is sexual assault?

Sexual assault is any kind of sexual activity, contact, or experience that happens without your consent. That means the sexual activity happens even though you don't agree to it.

Sexual assault may happen with:

  • Physical force or threats of force
  • Sexual coercion (being pressured, tricked, threatened, or forced in a nonphysical way)
  • Alcohol or drugs, including date rape drugs

Sexual assault may also be called sexual violence or sexual abuse. It affects millions of people each year. Anyone can be a victim of sexual assault. Many victims first experience sexual assault during childhood. Most victims are girls and women. But many boys and men are also victims of sexual assault.

If you've been sexually assaulted, it's never your fault. It's something that happens to you.

What does sexual assault include?

Sexual assault is any unwanted sexual activity, including:

  • Sexual activity with physical contact, which is everything from sexual touching or kissing to rape or attempted rape
  • Sexual activity without physical contact, which includes things that may happen in person, online, or through texts, such as:
    • "Flashing" or exhibitionism (when someone shows you their genitals without asking you for permission)
    • Being forced to look at sexual images or pose for sexual photos
    • Being sent unwanted texts with sexual photos or messages
    • Voyeurism (when someone watches private sexual acts without permission)
    • Getting sexual threats or being sexually harassed (unwelcome sexual comments, requests for sexual favors, or other sexual behavior that's ongoing)

Any sexual activity that happens without your consent is sexual assault.

What does "consent" mean?

Giving your consent means that you clearly and freely say "yes" to sexual activity. Your consent means that you:

  • Know and understand what's going on.
  • Can say what you want to do and don't want to do.
  • Are not underage.
  • Are not being pressured or tricked to do things you don't want to do.

Giving consent is not:

  • Silence. Not saying "no" doesn't mean you're saying "yes."
  • Having consented in the past. Having said "yes" to sex with someone in the past doesn't mean that you've agreed to all sexual activity in the future. That's true when you're dating or in a lasting relationship.
  • Being passive and not fighting off an attacker.

You cannot give consent if you are:

  • Drugged, drunk, passed out, or asleep.
  • Mentally unable to consent due to illness or disability.
  • Underage (States have different laws about how old you must be to give legal consent to sexual activity.).
  • Sexually coerced. This means that someone is pressuring you to participate in sexual activity. Agreeing to sex under pressure is not giving consent. The pressure may include:
    • Abusing power over you, for example, a boss threatening your job.
    • Making threats to harm people you care about.
    • Making false promises to reward you for sex.
    • Threatening to end a relationship or spread rumors about you.
    • Wearing you down by constantly asking for sex or making you feel guilty or obligated.

Who commits sexual assault?

Both men and women commit sexual assault. A person who commits sexual assault may be a stranger, but more often it's someone you know, for example:

  • A friend or acquaintance
  • Someone you work with
  • A neighbor
  • A family member
  • A current or past romantic partner, including a spouse

What are the possible health effects from sexual assault?

Sexual assault may have many health effects. Many of them can affect your lifelong health and well-being. The effects may include:

  • Physical effects such as:
    • Bruises or genital injuries
    • Sexually transmitted diseases
    • Pregnancy
    • Ongoing problems with:
      • Female reproductive health
      • Digestive disorders
      • Your heart
      • Sexual health
  • Psychological effects such as:
    • Depression or anxiety
    • Thoughts about suicide
    • Post-traumatic stress disorder (PTSD)

Sexual assault victims are more likely to smoke, have an alcohol use disorder (AUD), use illegal drugs, and have risky sexual behavior. Girls who experience sexual violence are more likely to become victims of intimate partner violence in adulthood.

What can I do if I'm a victim of sexual assault?

If you are in danger or need medical care, call 911. If you can, get away from the person who assaulted you and get to a safe place as fast as you can.

You can call the National Sexual Assault Hotline at 800-656-HOPE (4673) to connect with a sexual assault service provider in your area who can direct you to local resources.

Getting support after a sexual assault may help you cope better and reduce the long-term effects. Victim services like rape crisis centers may provide a safe, healing place where you can find support.

Studies show that treatments such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) can help victims cope with depression, anxiety, and post-traumatic stress disorder.

Can sexual assault be prevented?

Sexual assault is never the victim's fault. No one who has been assaulted should be blamed for something that they did or did not do.

You can take some steps to try to be safer around others:

  • Go to parties with friends. Look out for each other. If a friend seems drunk or drugged, get them to a safe place. Have a plan for how you'll get home, too.
  • Keep control of your drink. Someone could add alcohol or put a drug in it without you knowing.
  • Meet people for the first time in a public place.
  • Listen to your "gut feelings." If you feel uncomfortable around someone, leave.
  • Pay attention to your surroundings. When walking alone, stay in busy well-lit areas. And don't wear headphones; you want to be able to hear what's happening around you.

Centers for Disease and Control and Prevention


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Code History

  • FY 2024 - No Change, effective from 10/1/2023 through 9/30/2024
  • FY 2023 - No Change, effective from 10/1/2022 through 9/30/2023
  • FY 2022 - No Change, effective from 10/1/2021 through 9/30/2022
  • FY 2021 - No Change, effective from 10/1/2020 through 9/30/2021
  • FY 2020 - No Change, effective from 10/1/2019 through 9/30/2020
  • FY 2019 - No Change, effective from 10/1/2018 through 9/30/2019
  • FY 2018 - No Change, effective from 10/1/2017 through 9/30/2018
  • FY 2017 - No Change, effective from 10/1/2016 through 9/30/2017
  • FY 2016 - New Code, effective from 10/1/2015 through 9/30/2016. This was the first year ICD-10-CM was implemented into the HIPAA code set.

Footnotes

[1] Not chronic - A diagnosis code that does not fit the criteria for chronic condition (duration, ongoing medical treatment, and limitations) is considered not chronic. Some codes designated as not chronic are acute conditions. Other diagnosis codes that indicate a possible chronic condition, but for which the duration of the illness is not specified in the code description (i.e., we do not know the condition has lasted 12 months or longer) also are considered not chronic.