2026 ICD-10-CM Diagnosis Code T76.21XAAdult sexual abuse, suspected, initial encounter
T76.21XA is a billable ICD-10-CM diagnosis code for adult sexual 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 adult patients (age 15 through 124). 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
Code Classification
Code EditsBilling
Medicare Code Editor checks that affect claim validity for T76.21XA.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this 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 sexual abuse
- Suspected victim of elder sexual abuse
- Suspected victim of sexual abuse
- Suspected victim of sexual abuse by intimate partner
- Suspected victim of sexual grooming
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.
Patient EducationClinical
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.
The full article covers:
- What is sexual assault?
- What does sexual assault include?
- What does "consent" mean?
- Who commits sexual assault?
- What are the possible health effects from sexual assault?
- What can I do if I'm a victim of sexual assault?
- Can sexual assault be prevented?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert T76.21XA to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About T76.21XAOverview
Is T76.21XA (Adult sexual abuse, suspected) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report adult sexual abuse, suspected, initial encounter on HIPAA-covered claims from October 1, 2025 through September 30, 2026.
What does the 7th character A in T76.21XA mean?
The final character A marks the initial encounter: use it while the patient is receiving active treatment for adult sexual abuse, suspected, such as an emergency visit or first evaluation.
What MS-DRG does T76.21XA group to?
When adult sexual 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 T76.21XA be reported for?
The Medicare Code Editor checks adult sexual abuse, suspected, initial encounter against patient demographics: this code is intended for adult patients (age 15 through 124). Claims outside these limits are flagged as inconsistent.
What is the ICD-9 equivalent of T76.21XA?
Under the General Equivalence Mappings, adult sexual abuse, suspected, initial encounter converts to ICD-9-CM 995.83 (adult sexual 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.
