2026 ICD-10-CM Diagnosis Code T76.12XAChild physical abuse, suspected, initial encounter

ICD-10-CM Codes›S00–T88›T66-T78›T76

ICD-10-CM T76.12XA
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

T76.12XA is a billable ICD-10-CM diagnosis code for child physical abuse, suspected, initial encounter. The 7th character A marks it as an initial encounter code, used while the patient is receiving active treatment. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 922 through 923. The code is restricted by the Medicare Code Editor to pediatric patients (age 0 through 17). Coders also document this condition as non-accidental injury to child suspected. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under External cause codes: intent of injury, assault; External cause codes: other specified, classifiable and NEC; initial encounter; and Maltreatment/abuse.

Code Identity

ICD-10-CM Code
T76.12XA
Billable Status
Yes — Valid for Submission
Code Describes
Child physical abuse, suspected, initial encounter
Short Description
Child physical abuse, suspected, initial encounter
Same as the full description in the CMS dataset.
Parent Code
T76.12
Child physical abuse, suspected

Code Classification

ChapterS00–T88Injury, poisoning and certain other consequences of external causes
SectionT66-T78Other and unspecified effects of external causes
CategoryT76Adult and child abuse, neglect and other maltreatment, suspected
This CodeT76.12XAChild physical abuse, suspected, initial encounter

Code EditsBilling

Medicare Code Editor checks that affect claim validity for T76.12XA.

Pediatric diagnoses
The Medicare Code Editor detects inconsistencies in pediatric cases by checking a patient's age and any diagnosis on the patient's record. The pediatric code edits apply to patients age range is 0–17 years inclusive (e.g., Reye's syndrome, routine child health exam).

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Non-accidental injury to child suspected
  • Suspected victim of abuse by intimate partner
  • Suspected victim of child abuse
  • Suspected victim of child physical abuse
  • Suspected victim of physical abuse
  • Suspected victim of physical abuse by intimate partner

Coding GuidelinesGuidance

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 applicable episode of care:

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

Source: ICD-10-CM Official Guidelines for Coding and Reporting, FY 2026, published by CMS and the National Center for Health Statistics.

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR EXT022
External cause codes: intent of injury, assault
Default principal diagnosis: inpatient No · outpatient No
CCSR EXT018
External cause codes: other specified, classifiable and NEC; initial encounter
Default principal diagnosis: inpatient No · outpatient No
CCSR INJ032
Maltreatment/abuse
Default principal diagnosis: inpatient Yes · outpatient Yes

Patient EducationClinical

Child Abuse

Child abuse is doing something or failing to do something that results in harm to a child or puts a child at risk of harm. Child abuse can be physical, sexual or emotional. Neglect, or not providing for a child's needs, is also a form of abuse.

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert T76.12XA to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
995.54 Child physical abuse
Approximate The match is approximate rather than exact.

Code HistoryHistory

FY 2016AddedAdded to the ICD-10-CM code setEffective October 1, 2015, the first year of ICD-10-CM.
FY 2017–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About T76.12XAOverview

Is T76.12XA (Child physical abuse, suspected) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report child physical abuse, suspected, initial encounter on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What does the 7th character A in T76.12XA mean?

The final character A marks the initial encounter: use it while the patient is receiving active treatment for child physical abuse, suspected, such as an emergency visit or first evaluation.

What MS-DRG does T76.12XA group to?

When child physical abuse, suspected, initial encounter is the principal diagnosis on an inpatient stay, it groups to MS-DRG 922, 923, with relative weights from 1.0177 to 1.7494 depending on complications. Higher weights mean higher Medicare reimbursement.

Who can T76.12XA be reported for?

The Medicare Code Editor checks child physical abuse, suspected, initial encounter against patient demographics: this code is intended for pediatric patients (age 0 through 17). Claims outside these limits are flagged as inconsistent.

What is the ICD-9 equivalent of T76.12XA?

Under the General Equivalence Mappings, child physical abuse, suspected, initial encounter converts to ICD-9-CM 995.54 (child physical abuse). The mapping is approximate, so confirm the match fits the documentation.

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.