2026 ICD-10-CM Diagnosis Code T76.22XAChild sexual abuse, suspected, initial encounter

ICD-10-CM Codes›S00–T88›T66-T78›T76

ICD-10-CM T76.22XA
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

T76.22XA is a billable ICD-10-CM diagnosis code for child 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 pediatric patients (age 0 through 17). 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
T76.22XA
Billable Status
Yes — Valid for Submission
Code Describes
Child sexual abuse, suspected, initial encounter
Short Description
Child sexual abuse, suspected, initial encounter
Same as the full description in the CMS dataset.
Parent Code
T76.22
Child sexual 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 CodeT76.22XAChild sexual abuse, suspected, initial encounter

Code EditsBilling

Medicare Code Editor checks that affect claim validity for T76.22XA.

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.

  • Alleged victim of sexual assault
  • Homicide and assault by fight, brawl and rape
  • Homicide or assault by rape
  • Suspected victim of abuse by intimate partner
  • Suspected victim of child abuse
  • Suspected victim of child 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.

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 Sexual Abuse

Sexual abuse is one form of child abuse. It includes a wide range of actions between a child and an adult or older child. Often these involve body contact, but not always. Exposing one's genitals to children or pressuring them for sex is sexual abuse. Using a child for pornography is also sexual abuse.

Read the full article at MedlinePlus

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

Convert T76.22XA to ICD-9-CMHistory

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

ICD-9-CM
995.53 Child sexual 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 T76.22XAOverview

Is T76.22XA (Child sexual abuse, suspected) a billable code?

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

What does the 7th character A in T76.22XA mean?

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

What MS-DRG does T76.22XA group to?

When child 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 T76.22XA be reported for?

The Medicare Code Editor checks child sexual 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 T76.22XA?

Under the General Equivalence Mappings, child sexual abuse, suspected, initial encounter converts to ICD-9-CM 995.53 (child 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.