T76.11XA
T76.11XA: Adult physical abuse, suspected, initial encounter
Billable / specific codeICD-10-CM
T76.11XA is a billable, specific ICD-10-CM code for adult physical abuse, suspected, initial encounter. It is valid for submission on a claim.
Check T76.11XA with the rest of the claim: free scrubber7th character "A": initial encounter
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 T76.11XA
A category’s note binds every code beneath it.
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 T76.11XA
Their own Excludes1 notes name this code, so the conflict is not listed above.
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Medicare coverage
T76.11XA is named in 6 Medicare coverage policies: 6 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A53060Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
- A56612Billing and Coding: CT of the Head
- A56937Billing and Coding: Psychiatry and Psychology Services
- A57065Billing and Coding: Outpatient Psychiatry and Psychology Services
Code history
Unchanged in every release from FY2024 to FY2027.