2026 ICD-10-CM Diagnosis Code T76.91XAUnspecified adult maltreatment, suspected, initial encounter

ICD-10-CM Codes›S00–T88›T66-T78›T76

ICD-10-CM T76.91XA
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

T76.91XA is a billable ICD-10-CM diagnosis code for unspecified adult maltreatment, 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). Coders also document this condition as suspected domestic abuse. 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
T76.91XA
Billable Status
Yes — Valid for Submission
Code Describes
Unspecified adult maltreatment, suspected, initial encounter
Short Description
Unspecified adult maltreatment, suspected, initial encounter
Same as the full description in the CMS dataset.
Parent Code
T76.91
Unspecified adult maltreatment, 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 CodeT76.91XAUnspecified adult maltreatment, suspected, initial encounter

Code EditsBilling

Medicare Code Editor checks that affect claim validity for T76.91XA.

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).

Approximate SynonymsGuidance

Alternate terms and clinical phrases that map to this code.

  • Suspected domestic abuse
  • Suspected elderly person maltreatment
  • Suspected victim of abuse by intimate partner
  • Suspected victim of adult abuse

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

Convert T76.91XA to ICD-9-CMHistory

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

ICD-9-CM
995.80 Adult maltreatment NOS
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 T76.91XAOverview

Is T76.91XA (Unspecified adult maltreatment, suspected) a billable code?

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

What does the 7th character A in T76.91XA mean?

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

What MS-DRG does T76.91XA group to?

When unspecified adult maltreatment, 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 T76.91XA be reported for?

The Medicare Code Editor checks unspecified adult maltreatment, 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 T76.91XA?

Under the General Equivalence Mappings, unspecified adult maltreatment, suspected, initial encounter converts to ICD-9-CM 995.80 (adult maltreatment NOS). 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.