T76.91XS — Unspecified adult maltreatment, suspected, sequela
T76.91XS is a billable, specific ICD-10-CM code for unspecified adult maltreatment, suspected, sequela. It is valid for submission on a claim.
7th character "S" — sequela
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 T76.91XS
These are not written on T76.91XS, but they bind it: a note on a category applies to every code beneath it. Billing T76.91XS 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 T76.91XS
These codes carry an Excludes1 note pointing at T76.91XS. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading T76.91XS alone.
Risk adjustment
T76.91XS 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.
Medicare coverage
T76.91XS is named in 2 Medicare coverage policies — 2 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A53060Billing and Coding: Ophthalmology: Extended Ophthalmoscopy and Fundus Photography
- A57780Billing and Coding: Psychological and Neuropsychological Tests
Code history
T76.91XS has not changed since FY2024 — no addition, revision or deletion across the three most recent ICD-10-CM releases.
Related codes at this level
Codes that share T76.91. If T76.91XS is not quite right, the correct code is usually one of these.
Questions about T76.91XS
- Is T76.91XS a billable ICD-10-CM code?
- Yes. T76.91XS is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does T76.91XS 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 T76.91XS?
- T76.91XS 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 T76.91XS (T76) and apply to it just the same.