ICD-10 code S76.202S: Adductor muscle left thigh sequela

Key takeaways

ICD-10 code S76.202S is billable and covers an unspecified injury of the adductor muscle, fascia and tendon of the left thigh, sequela.

The 7th character S means sequela, a late effect treated after the original adductor injury has finished healing.

Character D applies only while active treatment continues, so using D on a resolved injury is the most common denial cause on these claims.

A sequela claim needs the left-side laterality, the original injury date, and a written link between the two.

Practice management software like Pabau keeps ICD-10-CM codes attached to the encounter and submits US claims through the Claim.MD clearinghouse.

ICD-10 code S76.202S covers the sequela of an unspecified injury to the adductor muscle, fascia and tendon of the left thigh. The original groin injury has healed. What it left behind, the stiffness, the weakness, the scar tissue, is what you now treat and bill for. That distinction sets the 7th character, which decides whether the claim pays.

Choose D instead of S and the record misstates the phase of care. Drop the 7th character altogether and the payer rejects the code as invalid. Both mistakes are easy to avoid once you can read S76.202S position by position.

S76.202S at a glance, before you code it

S76.202S is a specific, billable ICD-10-CM code, valid for the current fiscal year under the CMS ICD-10-CM code set. The table below holds the facts worth confirming before a claim goes out.

Every character in this code is a decision

Every character in S76.202S carries a meaning, and misreading one position produces the wrong code. The breakdown below maps each position to the decision behind it.

• S puts the code in Chapter 19 of ICD-10-CM, injury, poisoning and certain other consequences of external causes (S00-T88).
• 76 names the category: injury of muscle, fascia and tendon at hip and thigh level. Bone fractures at this level are not in S76. They fall under S72, fracture of femur.
• .2 narrows it to the adductor muscle, fascia and tendon. Compare .1 for quadriceps and .3 for the posterior muscle group at thigh level.
• 0 in the fifth position means the injury type is unspecified. The record names no strain, laceration, or contusion.
• 2 in the sixth position means the left thigh. In this category 1 is the right thigh and 9 is an undocumented side.
• S in the seventh position means sequela. The original injury has completed its healing phase and a late effect remains.

That fifth character trips up more coders than any other. “Unspecified” in the description does not mean the side is unknown.

The left thigh is stated outright by the sixth character. What went undocumented was the mechanism, whether the adductor was strained, lacerated, or bruised.

A, D, or S: Picking the right 7th character

S76.202 accepts three 7th characters, A, D and S. Each one tells the payer which phase of care the visit belongs to.

The CDC/NCHS ICD-10-CM official tool lists all three for this subcategory. Choosing between them is a reading of the record, not a preference.

A and S are rarely confused. The line between D and S is the one that gets crossed.

How to tell sequela from a subsequent encounter

Reach for S76.202S once the original injury has healed and only its after-effects remain under treatment.

ICD-10-CM Official Guidelines Section I.B.10 defines a sequela as a late effect. It is a condition arising from a prior injury, once the acute phase of that injury is complete.

All three of these have to hold before the S applies:

• The original adductor injury of the left thigh has healed, or the acute treatment phase has ended.
• The patient presents with a residual condition, such as chronic medial thigh pain, restricted motion, or functional weakness.
• The record explicitly ties that residual condition back to the original injury event.

S76.202D stays in play while active treatment of the original injury continues. That includes therapy inside a documented acute plan, and follow-up imaging during the healing window. Duration alone does not move you to sequela. A six-month course of active rehabilitation is still a subsequent encounter.

The practical trigger is a word in the note. Once the clinician writes “resolved”, “healed”, or “no longer acutely active”, any related ongoing complaint becomes a sequela.

Why S76.202 on its own will never pay

S76.202 without a 7th character is not billable, and payers reject it as an invalid code at intake. It sits at the bottom of a five-tier hierarchy, and only the bottom tier is claimable.

The AAPC ICD-10-CM code browser is a quick way to walk those tiers when documentation runs thin.

Notice that the rejection for a truncated code is not a clinical denial. It comes back as an invalid code, usually before a human at the payer has looked at the visit. That makes it cheap to prevent and annoying to fix, because the whole claim has to be corrected and resubmitted.

What the record has to prove for a sequela claim

A sequela claim has to prove a causal chain, not just a current complaint. That is a heavier documentation load than an initial or subsequent encounter carries.

Guidelines Section I.B.10 also sets the sequencing: the residual condition is coded first, then the sequela code follows it.

For S76.202S, the record needs four elements:

• Confirmation that the original adductor injury has resolved. The notes should say that acute treatment has ended and the injury is healed or in its late-effect phase.
• Explicit left-side laterality. A note reading only “medial thigh pain” cannot support S76.202S over S76.209S, the unspecified-side code.
• A causal link, in the clinician’s own words. A phrase such as “chronic adductor tightness secondary to left thigh adductor strain sustained [date]” is enough to satisfy this.
• The nature of the residual condition. Name it: weak hip adduction, myofascial scarring, persistent medial thigh pain. This is what supports medical necessity for continued therapy.

From encounter to remittance, in five steps

It helps to see where a sequela claim can break. Here is the path a single visit takes:

1. The clinician documents the residual condition, states the left side, and links it to a dated original injury.
2. The coder sequences the residual condition first, then adds S76.202S behind it.
3. The diagnosis pairs with the CPT code for the service on the charge line, for example 97110 for therapeutic exercise.
4. The claim leaves as an electronic professional claim, or a CMS-1500 on paper, and the clearinghouse screens it for format errors.
5. The payer answers with an electronic remittance advice, carrying a CARC code on any line it refuses.

A truncated code fails at step four, fast and cheaply. Missing causal statements survive all five steps, then fail at review, sometimes months after payment. That second failure is the expensive one.

The neighboring codes that get picked by mistake

S76.202S sits in a tight family of adductor codes, and the near misses matter as much as the code itself.

Two questions separate them: was the injury type documented, and which side was it? Run those two questions against the table before you commit.

The adductor-versus-hamstring mix-up is the classic one. Adductors run down the medial thigh and hamstrings sit at the back, so S76.2xx and S76.3xx cover different muscle groups.

Groin pain can come from either, and a note reading “posterior medial thigh” does not settle it. Query the provider, then pull the matching code from our diagnostic code library.

Five errors that get adductor sequela claims denied

Adductor sequela claims come back for a short and predictable list of reasons. Each one is caught by a check that takes seconds.

• Using D for a resolved injury. This is the most common error on adductor claims. Once the note says the injury has healed, D no longer fits and S is required. Submitting D after the acute phase ends misstates the encounter type.
• Submitting S76.202 with no 7th character. The truncated code is not billable, so payers reject it at intake. It lands on the remittance as an invalid code rather than a clinical denial.
• Defaulting to S76.209S when the note says left. The unspecified-side code is not the safe option. It is a coding error, and some payers treat laterality specificity as a condition of payment.
• Confusing adductor codes with hamstring codes. S76.2xx and S76.3xx both live in S76 and both cover thigh muscle injuries. Confirm medial versus posterior in the note before you choose.
• Leaving out the original injury date. Sequela coding needs a traceable prior injury. Without a date, a payer can deny the claim for thin evidence that the earlier event happened.

Tracking these separately is worth the effort. Sequela denials have their own causes, so lumping them into a general denial report hides the pattern.

Sort rejections by CARC code and the repeat offender in your practice usually shows up within a billing cycle.

What brings the patient back months later

Two histories account for most S76.202S visits: a sports-related acute strain, and a traumatic contusion from a fall or a direct blow. Both can leave something behind once the acute phase closes.

The adductor group runs along the medial thigh and handles hip adduction and rotational stability. It includes the adductor longus, adductor magnus, adductor brevis, gracilis, and pectineus.

Acute strains most often hit the adductor longus at its proximal musculotendinous junction. Without full rehabilitation, scar tissue can cut flexibility and leave chronic medial thigh pain long after healing.

In practice, four presentations lead to a sequela encounter:

• Chronic medial thigh tightness. The patient reports pulling or restriction during hip abduction work, months after a documented groin strain, with measurably reduced range compared to the other side.
• Functional weakness in hip adduction. Manual muscle testing shows a strength deficit on the left, consistent with fibrotic change in the adductor musculature.
• Post-contusion myositis ossificans. A blow to the medial thigh occasionally produces bone formation inside the muscle. Late-stage management of that codes as a sequela of the original contusion.
• Scarring after adductor repair. Patients who had a complete tear repaired can return with adhesions limiting function. That residual limitation is a sequela of the injury, not a new post-surgical condition.

All four share one billing feature. The functional deficit has to be measured and written down, because that measurement is what justifies the therapy you go on to bill.

Where Pabau fits into your sequela coding workflow

The sequela decision usually gets made twice. A clinician writes the note, then a coder reads it days later and works out which 7th character the wording supports. If the note never says “healed” or “resolved”, the coder either guesses or raises a query, and the claim waits.

Practice management software like Pabau keeps that decision in one place. The ICD-10-CM and CPT lookup libraries sit inside the client record. So the code gets attached to the service at the encounter, not reconstructed later.

Pabau’s claims management software then pre-fills the claim form from the record, and checks the required fields before the send button unlocks.

On the US pipeline, claims route to the Claim.MD clearinghouse, with eligibility checks, claim-status tracking, and remittance posting in the same place.

When a sequela claim comes back short paid, you can see which line the payer refused without opening a second system.

Keep ICD-10 codes attached to the encounter

Pabau lets sports medicine and physical therapy practices assign ICD-10-CM codes inside the client record, then submit and track US claims through the Claim.MD clearinghouse. See how that fits the way your practice already works.

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Conclusion

The clinical picture barely changes between a D claim and an S claim. One sentence in the note changes: whether the original injury is still under treatment or has finished healing. Get that sentence written and the 7th character picks itself.

So move the check upstream, into the encounter rather than the billing review. Ask for the healing status, the side, and the date of the original injury while the patient is still in the room. Sequela claims that carry all three rarely come back.

If your practice codes musculoskeletal sequela visits every week, fixing the note template pays off faster than appealing denials one at a time. Book a demo to see how Pabau keeps ICD-10-CM codes on the encounter and gets the claim out the same day.

Continue your research

Need to understand how clearinghouse claim submission works? Claim.MD clearinghouse overview explains how electronic claim routing reduces rejection rates for musculoskeletal and injury codes.

Handling a high volume of injury claim denials? Denial codes in medical billing covers the most common CARC and RARC codes that appear on rejected musculoskeletal claims.

Want a clean claim checklist before submission? What makes a clean claim outlines the payer requirements that prevent sequela and injury code rejections at intake.

Trying to read why a sequela line was refused? Electronic remittance advice explained shows how to trace a denial back to the documentation element that failed.

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