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T76.12XA ICD-10-CM Code: Child physical abuse, suspected, initial encounter

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

7th character
Required — see the character table on this page
Tabular directives
6 Excludes1 · 1 use-additional code · 6 code-also instructions

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v44, Appendix B.

  • MS-DRG 922 — OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC (MDC 21)
  • MS-DRG 923 — OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC (MDC 21)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for T76.12XA in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on T76.12XA itself; “inherited from” names the category or block whose note applies here.

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Source: inherited from T76

Code Also

Additional codes that may be required to fully describe the encounter.

  • Code also, if applicable, place of occurrence, such as:
  • highway rest stop (Y92.523)
  • school (private) (public) (state) as the place of occurrence of the external cause (Y92.21-)
  • service areas as the place of occurrence of the external cause (Y92.52-)
  • single-family non-institutional (private) house as the place of occurrence of the external cause (Y92.01-)
  • transport vehicle as the place of occurrence of the external cause (Y92.81-)

Source: inherited from T66-T78

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code, if applicable, to identify any associated current injury

Source: inherited from T76

7th Character Guide

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

  • A — initial encounter (this page’s code)
  • D — subsequent encounter
  • S — sequela

How the encounter character is assigned. “Initial encounter” means the patient is receiving active treatment for the condition — it is not limited to the first visit, and a different or new provider giving active treatment still assigns it. “Subsequent encounter” covers care during the healing or recovery phase after active treatment. “Sequela” is for complications or conditions that arise as a direct result of the original condition.

ICD-10-CM Official Guidelines for Coding and Reporting, Section I.C.19.a (paraphrased by MedCoder).

Variant codes in this family

T76.12XA, T76.12XD, T76.12XS

Character meanings are CMS's official 7th-character extensions for this family, as carried in each variant code's official description; variant codes are registry rows. The explanation of how the encounter character is assigned is MedCoder editorial, distinct from the official content above it.

Coder workflow for T76.12XA

MedCoder structured workflow — derived from this code’s own official record

Before you code T76.12XA

  1. A 7th character is required in this family. Confirm the documented encounter: initial (active treatment), subsequent (healing or recovery phase), or sequela. This page’s code carries “A”. “Initial” means active treatment, not the first visit (Guidelines I.C.19.a).

    See the 7th Character Guide · Guide: 7th characters: initial, subsequent, sequela →

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with T76.12XA. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in T76.12XA’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewT74, O9A.3, O9A.4, O9A.5, Z04.71, Z04.41

  2. Is the encounter phase documented — active treatment, healing or recovery, or a sequela?
    Yes → Assign the matching 7th character; the variant codes are in the 7th Character Guide.
    No → The code is invalid without its 7th character — query for the missing element.

Consider T76.12XA. Then work the Use Additional Code note and review the Code Also note, and confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Encounter type
Active treatment, healing or recovery phase, or sequela — the basis of the 7th character (Guidelines I.C.19.a).
The conditions the Use Additional Code note names
Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.

Official instructions as workflow

  • Excludes1 — check before selecting T76.12XA(6 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with T76.12XA: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareT74, O9A.3, O9A.4, O9A.5, Z04.71, Z04.41

    See the official tabular notes · Guidelines I.A.12.a

  • Use Additional Code — after identifying T76.12XA(1 note)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with T76.12XA when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    See the official tabular notes · Guidelines I.A.13

  • Code Also — related condition(6 notes)

    Coding workflow: Review the related condition when both are documented and the instruction applies. A Code Also note does not fix sequencing; the order follows the circumstances of the encounter.

    ReviewY92.523, Y92.21, Y92.52, Y92.01, Y92.81

    See the official tabular notes · Guidelines I.A.17

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition T76.12XA describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewT74, O9A.3, O9A.4, O9A.5, Z04.71, Z04.41

Documentation: The patient returns during the healing or recovery phase after active treatment of the same condition.

Coding question: Which 7th character applies?

Path: Review the official 7th-character definitions for this family in the 7th Character Guide.

Reason: “Initial encounter” means active treatment, not the first visit; care during recovery takes “subsequent encounter”, and a complication arising from the original condition takes “sequela” (Guidelines I.C.19.a).

Documentation: A condition the Use Additional Code note names is documented.

Coding question: Is a second code reported with T76.12XA?

Path: Review the Use Additional Code note and the code it names.

Reason: The additional code is reported when the record documents the condition; a conditional instruction applies only when its condition is met (Guidelines I.A.13).

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Don’t confuse T76.12XA with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of T76.12XA — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • T74— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of adult and child maltreatment, confirmed moves the case to T74; the two are not reported together unless documented as unrelated.

    Full comparison: T76.12XA vs T74 →

  • O9A.3— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of suspected abuse and maltreatment in pregnancy moves the case to O9A.3; the two are not reported together unless documented as unrelated.

    Full comparison: T76.12XA vs O9A.3 →

  • O9A.4— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of suspected abuse and maltreatment in pregnancy moves the case to O9A.4; the two are not reported together unless documented as unrelated.

    Full comparison: T76.12XA vs O9A.4 →

  • O9A.5— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of suspected abuse and maltreatment in pregnancy moves the case to O9A.5; the two are not reported together unless documented as unrelated.

    Full comparison: T76.12XA vs O9A.5 →

  • Z04.71— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of suspected adult physical abuse, ruled out moves the case to Z04.71; the two are not reported together unless documented as unrelated.

    Full comparison: T76.12XA vs Z04.71 →

  • Z04.41— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of suspected adult sexual abuse, ruled out moves the case to Z04.41; the two are not reported together unless documented as unrelated.

    Full comparison: T76.12XA vs Z04.41 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Code Overview

Child physical abuse, suspected, initial encounter is a billable ICD-10-CM diagnosis code (T76.12XA).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Official Coding Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Chapter 5: Mental, Behavioral and Neurodevelopmental disorders (F01 – F99)

on another” or “factitious disorder by proxy.” The perpetrator, not the victim, receives this diagnosis. Assign code F68.A, Factitious disorder imposed on another, to the perpetrator’s record. For the victim of a patient suffering from MSBP, assign the appropriate code from categories T74, Adult and child abuse, neglect and other maltreatment, confirmed, or T76, Adult and child abuse, neglect and other maltreatment, suspected.

Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)

f. Adult and child abuse, neglect and other maltreatment Sequence first the appropriate code from categories T74, Adult and child abuse, neglect and other maltreatment, confirmed, or T76, Adult and child abuse, neglect and other maltreatment, suspected, for abuse, neglect and other maltreatment, followed by any accompanying mental health or injury code(s).

Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)

If the documentation in the medical record states abuse or neglect, it is coded as confirmed (T74.-). It is coded as suspected if it is documented as suspected (T76.-).

Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)

If a suspected case of abuse, neglect or mistreatment is ruled out during an encounter code Z04.71, Encounter for examination and observation following alleged physical adult abuse, ruled out, or code Z04.72, Encounter for examination and observation following alleged child physical abuse, ruled out, should be used, not a code from T76.

Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)

If a suspected case of alleged rape or sexual abuse is ruled out during an encounter code Z04.41, Encounter for examination and observation following alleged adult rape or code Z04.42, Encounter for examination and observation following alleged child rape, should be used, not a code from T76.

Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)

If a suspected case of forced sexual exploitation or forced labor exploitation is ruled out during an encounter, code Z04.81, Encounter for examination and observation of victim following forced sexual exploitation, or code Z04.82, Encounter for examination and observation of victim following forced labor exploitation, should be used, not a code from T76.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. A 7th character applies in this family. Confirm the documented encounter matches the character assigned. See the official 7th-character definitions and this code’s variants
  2. 1 Use Additional Code instruction — report the named additional code(s) when the documentation supports them. See the Use Additional Code notes
  3. 6 Code Also notes — a second code may apply; the guidelines leave its sequencing to the circumstances of the encounter. See the Code Also notes
  4. 6 Excludes1 entries — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

  • Age-restricted: the Medicare Code Editor lists this as a pediatric (age 0-17) diagnosis; other ages are presumed incorrect.
  • CC as a secondary diagnosis (FY2027). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name T76.12XA or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 3 Excludes1 notes across 2 chapters: T74 — Adult and child abuse, neglect and other maltreatment, confirmed (via T76.-), Z04.71 — Encounter for examination and observation following alleged adult physical abuse (via T76.-), Z04.72 — Encounter for examination and observation following alleged child physical abuse (via T76.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 MS-DRG: CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 53 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 2 MS-DRGs: DRG 922 (MDC 21), DRG 923 (MDC 21).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):INJ032 — Maltreatment/abuse (default); EXT018 — External cause codes: other specified, classifiable and NEC; initial encounter; EXT022 — External cause codes: intent of injury, assault.

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

T74.61XD — Adult forced labor exploitation, confirmed, subsequent encounter, T74.61XS — Adult forced labor exploitation, confirmed, sequela, T74.62XA — Child forced labor exploitation, confirmed, initial encounter, T74.62XD — Child forced labor exploitation, confirmed, subsequent encounter, T74.62XS — Child forced labor exploitation, confirmed, sequela, T74.91XA — Unspecified adult maltreatment, confirmed, initial encounter, T74.92XA — Unspecified child maltreatment, confirmed, initial encounter, T76.01XA — Adult neglect or abandonment, suspected, initial encounter, T76.02XA — Child neglect or abandonment, suspected, initial encounter, T76.11XA — Adult physical abuse, suspected, initial encounter, T76.21XA — Adult sexual abuse, suspected, initial encounter, T76.21XD — Adult sexual abuse, suspected, subsequent encounter, T76.21XS — Adult sexual abuse, suspected, sequela, T76.22XA — Child sexual abuse, suspected, initial encounter, T76.22XD — Child sexual abuse, suspected, subsequent encounter, T76.22XS — Child sexual abuse, suspected, sequela, T76.31XA — Adult psychological abuse, suspected, initial encounter, T76.32XA — Child psychological abuse, suspected, initial encounter, T76.51XA — Adult forced sexual exploitation, suspected, initial encounter, T76.51XD — Adult forced sexual exploitation, suspected, subsequent encounter, +32 more

Same injury, other encounter phase

Same injury, coded at a different phase of treatment via the 7th character.

T76.12XD — Child physical abuse, suspected, subsequent encounterCompare T76.12XA vs T76.12XD →, T76.12XS — Child physical abuse, suspected, sequelaCompare T76.12XA vs T76.12XS →

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical categories (Maltreatment/abuse, External cause codes: other specified, classifiable and NEC; initial encounter, External cause codes: intent of injury, assault).

T74.4XXA — Shaken infant syndrome, initial encounter, T74.51XA — Adult forced sexual exploitation, confirmed, initial encounter, T74.52XA — Child sexual exploitation, confirmed, initial encounter, T74.61XA — Adult forced labor exploitation, confirmed, initial encounter, T74.62XA — Child forced labor exploitation, confirmed, initial encounter, T74.91XA — Unspecified adult maltreatment, confirmed, initial encounter, T74.92XA — Unspecified child maltreatment, confirmed, initial encounter, T76.01XA — Adult neglect or abandonment, suspected, initial encounter, T76.02XA — Child neglect or abandonment, suspected, initial encounter, T76.11XA — Adult physical abuse, suspected, initial encounter, T76.21XA — Adult sexual abuse, suspected, initial encounter, T76.22XA — Child sexual abuse, suspected, initial encounter, T76.31XA — Adult psychological abuse, suspected, initial encounter, T76.32XA — Child psychological abuse, suspected, initial encounter, T76.51XA — Adult forced sexual exploitation, suspected, initial encounter, T76.52XA — Child sexual exploitation, suspected, initial encounter, T76.61XA — Adult forced labor exploitation, suspected, initial encounter, T76.62XA — Child forced labor exploitation, suspected, initial encounter, T76.91XA — Unspecified adult maltreatment, suspected, initial encounter, T76.92XA — Unspecified child maltreatment, suspected, initial encounter, +816 more

Contextual Map

Every relationship of T76.12XA in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run T76.12XA with these 3 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • MDC 21 — Injuries, Poisonings and Toxic Effects of Drugs[MDC crossing]: “Injuries, Poisonings and Toxic Effects of Drugs — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 32,063 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027

Nearest codes (40)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Common coding questions

Does T76.12XA require a 7th character?

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

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2027), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v44 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "T76.12XA — Child physical abuse, suspected, initial encounter." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/t76.12xa-child-physical-abuse-suspected-initial-encounter

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Child physical abuse, suspected, initial encounter

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027, and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to T76.12XA in its code family, with their registry titles.

View all codes in the T76 family