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S76.319A
ICD-10-CM
Hamstring Muscle Strain

Find information on hamstring muscle strain diagnosis, including clinical documentation, ICD-10 codes (S73.4), medical coding guidelines, and healthcare best practices. Learn about hamstring injury symptoms, treatment options, and recovery timelines. This resource covers hamstring tear, strain, and pull diagnosis for accurate medical record keeping and billing. Explore relevant medical terminology and documentation tips for healthcare professionals.

Also known as

Hamstring Strain
Pulled Hamstring

Diagnosis Snapshot

Key Facts
  • Definition : A tear or stretch in the hamstring muscles at the back of the thigh.
  • Clinical Signs : Pain in the back of the thigh, stiffness, bruising, swelling, and weakness.
  • Common Settings : Sports injuries, sudden movements, overuse from running or jumping.

Related ICD-10 Code Ranges

Complete code families applicable to AAPC S76.319A Coding
S56.1

Sprain and strain of hamstring

Injury to hamstring muscle, including strains and tears.

S56

Injury of muscle, fascia and tendon at lower leg

Muscle, fascia, and tendon injuries of lower leg, excluding ankle and foot.

M62.83

Other muscle disorders of lower leg

Other specified disorders affecting muscles in the lower leg.

S76

Injury of muscle, fascia and tendon at hip and thigh

Muscle, fascia, and tendon injuries at hip and thigh levels.

Code-Specific Guidance

Decision Tree for

Follow this step-by-step guide to choose the correct ICD-10 code.

Is the hamstring strain traumatic?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Hamstring muscle strain
Hamstring tendonitis
Hamstring avulsion fracture

Documentation Best Practices

Documentation Checklist
  • Hamstring strain laterality (left/right)
  • Detailed injury mechanism/onset
  • Palpation findings/point tenderness
  • ROM limitations/pain with motion
  • Muscle strength assessment grade

Mitigation Tips

Best Practices
  • Document precise hamstring strain location (proximal, distal) for accurate ICD-10 coding (S76.1-, S26.1-).
  • Specify laterality (right, left) and grade (1, 2, 3) of hamstring strain in clinical notes for improved CDI.
  • Use standardized terminology (e.g., partial tear, complete rupture) for compliant hamstring injury documentation.
  • Correlate physical exam findings (palpation, range of motion) with imaging results for compliant medical coding.
  • Ensure proper E/M coding based on complexity of hamstring strain diagnosis and treatment for healthcare compliance.

Clinical Decision Support

Checklist
  • 1. Localized posterior thigh pain onset with sprinting, stretching
  • 2. Palpable tenderness, hematoma, ecchymosis in posterior thigh
  • 3. Pain with resisted knee flexion, hip extension
  • 4. Reduced ROM, strength. ICD-10 S76.1, S26.1 Documented
  • 5. Neurovascular exam normal. R/O avulsion fx, sciatica

Reimbursement and Quality Metrics

Impact Summary
  • Hamstring Muscle Strain reimbursement depends on accurate coding (ICD-10 S76.1-, S26.1-, or related codes) and documentation supporting medical necessity.
  • Coding errors impact hamstring strain injury claim denials and reimbursements. Accurate Evaluation and Management (E/M) coding is crucial.
  • Quality metrics for hamstring strain include return-to-activity time, pain reduction, and patient satisfaction. Accurate diagnosis coding impacts these metrics.
  • Hospital reporting on hamstring strain diagnoses uses ICD-10 codes. Accurate coding improves data quality for population health management and resource allocation.

Streamline Your Medical Coding

Let S10.AI help you select the most accurate ICD-10 codes. Our AI-powered assistant ensures compliance and reduces coding errors.

Frequently Asked Questions

Common Questions and Answers

Q: What are the most effective differential diagnostic considerations for proximal hamstring tendinopathy versus hamstring muscle strain in athletes?

A: Differentiating between proximal hamstring tendinopathy and hamstring muscle strain can be challenging due to overlapping symptoms. Key considerations include: location of pain (localized ischial tuberosity tenderness suggests tendinopathy, while more distal posterior thigh pain indicates a strain), pain quality (dull ache with tendinopathy versus sharp pain with strain), and aggravating factors (pain with prolonged sitting or stretching for tendinopathy, pain with sprinting or forceful contractions for a strain). Palpation can reveal localized tenderness over the ischial tuberosity in tendinopathy. Imaging, such as MRI, can confirm the diagnosis and differentiate partial tears from complete tears in a muscle strain or assess tendon involvement. Explore how a thorough history and physical exam, combined with selective use of imaging, can help distinguish between these conditions and inform appropriate management strategies. Consider implementing standardized assessment tools like the HAGOS (Hamstring Outcome Score) for accurate diagnosis and tracking of patient progress. Learn more about the nuanced approach to hamstring injuries through our dedicated clinical resources.

Q: How do I accurately grade hamstring muscle strain severity using physical examination findings and imaging results for optimal rehabilitation planning?

A: Accurate grading of hamstring muscle strains is essential for effective rehabilitation planning. Grade 1 strains involve mild stretching of the muscle fibers with minimal pain and functional loss. Grade 2 strains involve partial tearing of muscle fibers with moderate pain, swelling, and noticeable functional impairment. Grade 3 strains are complete muscle tears resulting in severe pain, significant swelling, palpable defects, and inability to contract the muscle effectively. Physical examination findings, such as pain with palpation, range of motion testing, and muscle strength assessment, help to determine the severity. Imaging, particularly MRI, can confirm the diagnosis, pinpoint the location and extent of the tear, and differentiate between grades 2 and 3. Explore how a comprehensive approach utilizing both clinical and imaging data guides appropriate rehabilitation protocols. Consider implementing a progressive rehabilitation program tailored to the specific grade of the strain. Learn more about the evidence-based rehabilitation protocols for hamstring muscle strains through our comprehensive clinical guidelines.

Quick Tips

Practical Coding Tips
  • Code strain laterality (left/right)
  • ICD-10 S73.4xx for hamstring strain
  • Document injury mechanism for specificity
  • MRI/ultrasound supports coding complexity
  • Grade the strain (mild, moderate, severe)

Documentation Templates

Patient presents with complaints consistent with hamstring muscle strain.  Onset of posterior thigh pain occurred during [activity causing injury - e.g., sprinting, stretching, sudden movement] [number] daysweeks prior to this evaluation.  Pain is described as [character of pain - e.g., sharp, pulling, aching, burning] and localized to the [location - e.g., proximal, mid, distal] hamstring muscle group of the [rightleft] leg.  Patient reports [severity of pain - e.g., mild, moderate, severe] pain that is exacerbated by [aggravating factors - e.g., stretching, bending, walking, running] and relieved by [alleviating factors - e.g., rest, ice, elevation].  Physical examination reveals [tenderness, swelling, bruising, palpable defect, decreased range of motion] in the affected area.  Muscle strength testing demonstrates [strength grade - e.g., 55, 45, 35] strength in knee flexion and hip extension.  Differential diagnosis includes hamstring tendonitis, sciatica, lumbar radiculopathy, and muscle contusion.  Assessment: Hamstring muscle strain, [grade - e.g., grade I, grade II, grade III] of the [affected muscle - e.g., biceps femoris, semitendinosus, semimembranosus].  Plan: Conservative management including RICE therapy (rest, ice, compression, elevation), NSAIDs for pain management, and gentle stretching exercises as tolerated.  Patient education provided on activity modification and proper stretching techniques.  Follow-up appointment scheduled in [duration - e.g., one, two] weeks to assess progress and adjust treatment plan as needed.  Referral to physical therapy may be considered if symptoms persist or worsen.  ICD-10 code: S73.4XXA.