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S76.319A
ICD-10-CM
Hamstring Tear

Find comprehensive information on hamstring tear diagnosis, including clinical documentation, medical coding (ICD-10, S-codes), and healthcare resources. Learn about hamstring strain grades, symptoms, physical exam findings, and differential diagnoses. This resource provides guidance for accurate medical coding and documentation of hamstring injuries for physicians, clinicians, and medical coders. Explore details on hamstring tear treatment, prognosis, and return to activity guidelines.

Also known as

Hamstring Strain
Posterior Thigh Muscle Tear

Diagnosis Snapshot

Key Facts
  • Definition : A tear or strain in any of the three hamstring muscles at the back of the thigh.
  • Clinical Signs : Pain in the back of the thigh, bruising, swelling, stiffness, weakness, and difficulty walking.
  • Common Settings : Sports injuries, sudden movements, overuse, and muscle imbalances.

Related ICD-10 Code Ranges

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

Injury of hamstring muscle

Covers tears and other injuries to the hamstring muscles.

S76.-

Injury of muscle, fascia and tendon at lower leg level

Includes injuries to muscles, fascia, and tendons in the lower leg area.

S73.-

Injury of muscle, fascia and tendon at thigh level

Includes injuries to muscles, fascia, and tendons in the thigh area.

Code-Specific Guidance

Decision Tree for

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

Traumatic hamstring tear?

  • Yes

    Which leg?

  • No

    Strain or other non-traumatic tear?

Code Comparison

Related Codes Comparison

When to use each related code

Description
Hamstring tear
Hamstring strain
Sciatica

Documentation Best Practices

Documentation Checklist
  • Hamstring tear diagnosis: laterality, grade, location
  • Mechanism of injury: sudden stretch, contraction
  • Physical exam: palpable defect, pain, ROM
  • Imaging: MRI confirmation if necessary
  • ICD-10 code: S76.1, S76.11, S76.12 (specify)

Coding and Audit Risks

Common Risks
  • Laterality Coding Errors

    Missing or incorrect laterality (right, left, bilateral) for hamstring tear diagnoses can lead to claim rejections and inaccurate data.

  • Specificity of Diagnosis

    Coding a hamstring tear without specifying complete/partial or grade (1, 2, 3) impacts reimbursement and quality reporting.

  • Documentation Clarity Issues

    Vague documentation lacking clear diagnostic confirmation of a hamstring tear via physical exam or imaging can cause coding errors.

Mitigation Tips

Best Practices
  • Accurate ICD-10 coding (S76.1-, S26.1-) for hamstring tear
  • Detailed HPI, physical exam, imaging in documentation
  • Differential diagnosis documentation for compliance
  • Measure tear size for specific coding, improved CDI
  • Timely follow-up documentation supports medical necessity

Clinical Decision Support

Checklist
  • 1. Sudden posterior thigh pain during exertion? ICD-10: S76.1, S26.1 Document mechanism.
  • 2. Palpable tenderness/defect in hamstring? Document location, size. HPI consistent?
  • 3. Pain with resisted knee flexion? Neurovascular exam normal? Document.
  • 4. Consider imaging (MRI) if severe. Document justification for imaging choice.

Reimbursement and Quality Metrics

Impact Summary
  • Hamstring Tear: Coding accuracy impacts reimbursement for MRI, surgery, and physical therapy.
  • Accurate Hamstring Tear diagnosis coding improves hospital quality reporting metrics.
  • Proper E/M coding for Hamstring Tear initial visit affects physician reimbursement.
  • Timely and specific Hamstring Tear documentation impacts claim denial rates and hospital revenue cycle.

Streamline Your Medical Coding

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

Quick Tips

Practical Coding Tips
  • Code hamstring tear laterality
  • Specify strain vs tear
  • Document injury mechanism
  • Include MRI findings
  • Consider 7th character

Documentation Templates

Patient presents with complaints consistent with hamstring tear, possibly sustained during [activity causing injury].  Onset of symptoms occurred [timeframe] ago.  Patient reports [sharp, pulling, tearing] pain in the posterior thigh, localized to [proximal, mid, distal] hamstring musculature.  Pain is exacerbated by [activities that worsen pain, e.g., knee flexion, hip extension, stretching, weight-bearing].  Patient may also report symptoms such as [popping sensation, bruising, swelling, tenderness to palpation, muscle spasm, weakness, difficulty walking].  Physical examination reveals [positive findings, e.g., palpable defect, ecchymosis, limited range of motion, pain with resisted knee flexion or hip extension, positive Straight Leg Raise test, tenderness to palpation].  Differential diagnosis includes hamstring strain, muscle contusion, sciatica, avulsion fracture.  Severity of hamstring tear is suspected to be [grade 1, grade 2, grade 3] based on clinical presentation.  Imaging studies, such as ultrasound or MRI, may be ordered to confirm diagnosis and assess the extent of the tear.  Initial treatment plan includes RICE protocol (rest, ice, compression, elevation), pain management with NSAIDs or other analgesics as indicated, and physical therapy referral.  Patient education provided on activity modification, stretching, and strengthening exercises.  Follow-up scheduled in [timeframe] to reassess symptoms and adjust treatment plan as needed.  Prognosis for recovery depends on the severity of the tear and adherence to treatment recommendations.  ICD-10 code: [appropriate ICD-10 code, e.g., S76.1xxA, S76.1xxD, S76.1xxS].