Is T76.1 a billable ICD-10-CM code?

No. T76.1 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does T76.1 sit in the tabular list?

Injury, poisoning and certain other consequences of external causes (S00-T88), in the block Other and unspecified effects of external causes (T66-T78).

What cannot be coded together with T76.1?

T76.1 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above T76.1 (T76) and apply to it just the same.

T76.1

T76.1 — Physical abuse, suspected

Non-billable headerICD-10-CM

T76.1 is a non-billable header ICD-10-CM code for physical abuse, suspected. It cannot be billed on its own: choose one of the more specific child codes below. This code also requires a 7th character before it is complete.

This code requires a 7th character

The appropriate 7th character is to be added to each code from category T76

A: initial encounter
D: subsequent encounter
S: sequela

Excludes1 inherited from the categories above T76.1

These are not written on T76.1, but they bind it: a note on a category applies to every code beneath it. Billing T76.1 with anything listed here is a denial.

Written on T76 — Adult and child abuse, neglect and other maltreatment, suspected

adult and child maltreatment, confirmed (T74.-)
suspected abuse and maltreatment in pregnancy (O9A.3-, O9A.4-, O9A.5-)
suspected adult physical abuse, ruled out (Z04.71)
suspected adult sexual abuse, ruled out (Z04.41)
suspected child physical abuse, ruled out (Z04.72)
suspected child sexual abuse, ruled out (Z04.42)

Other codes that can never be billed with T76.1

These codes carry an Excludes1 note pointing at T76.1. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading T76.1 alone.

Z91.410Personal history of adult physical and sexual abuse
Z04.71Encounter for examination and observation following alleged adult physical abuse
Z04.72Encounter for examination and observation following alleged child physical abuse
Z62.810Personal history of physical and sexual abuse in childhood
T74Adult and child abuse, neglect and other maltreatment, confirmed

Risk adjustment

T76.1 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Code history

T76.1 has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.

Code to one of these instead T76.1

2 child codes. Green means billable.

Related codes at this level

Codes that share T76. If T76.1 is not quite right, the correct code is usually one of these.

Questions about T76.1

Is T76.1 a billable ICD-10-CM code?: No. T76.1 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does T76.1 sit in the tabular list?: Injury, poisoning and certain other consequences of external causes (S00-T88), in the block Other and unspecified effects of external causes (T66-T78).
What cannot be coded together with T76.1?: T76.1 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above T76.1 (T76) and apply to it just the same.