ICD code S76.221A – Right adductor muscle, fascia and tendon laceration

Key takeaways

S76.221A is the billable ICD-10-CM code for a laceration of the right adductor muscle, fascia and tendon during active treatment.

A right adductor strain codes to S76.211A, not S76.221A, so confirm the injury type in the clinical note before you assign either code.

The 7th character ‘A’ signals active treatment. Switch to ‘D’ for routine follow-up or rehabilitation visits, and use ‘S’ only when a sequela is documented.

Report the associated open wound of the thigh (S71.-) alongside S76.221A, as the S76 category instructs.

Missing laterality and the wrong 7th character are the two errors to check for before any S76.221A claim goes out.

ICD-10 Code S76.221A: Quick reference summary

ICD-10 Code S76.221A is the billable code for a laceration of the adductor muscle, fascia and tendon of the right thigh, at the initial encounter. It sits in the S76.2 subcategory, which covers adductor injuries of the thigh. The table below captures the reference data coders need before assigning it.

Verify current-year validity against the CDC/NCHS ICD-10-CM web tool before billing, as CMS releases annual updates that can affect code validity.

What S76.221A covers: Code descriptor explained

The descriptor for S76.221A has four distinct components, and clinical documentation must support each one before the code is assigned. Each component maps to one character of the code, as the breakdown below shows.

• Injury type: “Laceration” means a cut through the adductor muscle, fascia or tendon, usually with an open wound. The code covers lacerations only. In clinical practice, the presenting injury is most often a deep inner-thigh wound from glass, a blade, or sharp equipment.
• Specific structure: “Adductor muscle, fascia and tendon” confirms the code applies to the entire adductor complex at this level. It is not limited to one named muscle.
• Laterality: “Right thigh” is non-negotiable. If the chart documents left-side injury, S76.222A applies. If laterality is unspecified in the note, the code cannot be assigned without a clinical query.
• Encounter type: “Initial encounter” means the patient is still under active treatment. Once care transitions to monitoring, rehabilitation, or management of residual effects, the 7th character must change.

Coders should note that this code covers traumatic injury mechanisms. Overuse or chronic adductor tendinopathy with no acute event typically codes elsewhere in the musculoskeletal chapter (M-codes) rather than S76.221A. The S76 category also instructs you to code any associated open wound of the thigh (S71.-).

Strain vs laceration: A strain is an overstretch or tear of muscle fibers, often from a sudden change of direction, with the skin intact. A laceration is a cut through the tissue. A right adductor strain, often charted as a groin pull, codes to S76.211A instead. ICD-10-CM also has no code specific to the adductor longus, so a named adductor longus injury still codes to the S76.2- adductor group.

Understanding the 7th character: A, D, and S

The 7th character tells the payer where the patient is in their care. Assigning “A” to a follow-up visit can trigger payer edits and delay payment.

Per the ICD-10-CM Official Guidelines for Coding and Reporting, “initial encounter” does not mean literally the first visit. It means the patient is still in the active treatment phase. A patient who sees three different providers for the same injury during active treatment is coded “A” at each visit. That holds until treatment goals shift to rehabilitation or monitoring.

Codes to know: S76.221A parent, siblings, and related codes

The two structural errors to guard against on adductor laceration claims are the wrong side and the wrong injury type. The table below maps the S76.22- codes alongside their closest neighbors, so you can rule both out.

Use the AAPC Codify ICD-10-CM lookup or the ICD List browser to cross-check descriptor wording and code hierarchy before finalizing the claim.

Inclusion and exclusion notes for S76.221A

Knowing what the S76 category covers, and what its notes send elsewhere, keeps the code on the right injury.

What S76 covers:

• Traumatic injuries to muscles, fascia, and tendons at the hip and thigh level resulting from an identifiable acute event
• Adductor injuries split by type: strain (S76.21-), laceration (S76.22-), and other injury (S76.29-)
• Injuries sustained during sporting activity, falls, or workplace incidents where force is applied to the hip-adductor region

What S76 excludes (Excludes2 notes):

• Injuries of muscle, fascia and tendon at lower leg level (S86.-) — a muscle or tendon injury below the knee codes to S86.- instead
• Sprain of joints and ligaments of the hip (S73.1-) — a hip ligament injury codes to S73.1-, not to S76

Both are Excludes2 notes, so either code can sit alongside S76.221A when the patient has both injuries. Non-traumatic conditions fall outside S76 altogether. Overuse tendinopathy, chronic adductor pain without an acute event and degenerative muscle disorders code to M-codes.

Query the treating provider if the documentation does not clearly establish an acute traumatic mechanism. Coding a chronic overuse injury as S76.221A exposes the practice to medical necessity audit risk.

Documentation requirements for S76.221A

A claim submitted with S76.221A is only as defensible as the clinical note behind it. Auditors and payer reviewers expect the following elements to be explicitly stated, not inferred.

• Confirmed laterality: The note must state “right thigh” or “right adductor” explicitly. “Thigh laceration” without a side is insufficient to support S76.221A.
• Depth of the wound: Documentation should state that the laceration reaches the adductor muscle, fascia or tendon. A note that describes only a skin-level thigh wound supports S71.- alone, not S76.221A.
• Injury type: The note must describe a laceration, not a strain. An overstretch injury with intact skin codes to S76.211A.
• Acute injury mechanism: The provider should document what caused the wound, such as a fall onto sharp equipment, broken glass, or a blade.
• Encounter type justification: The note must reflect active treatment (wound exploration, surgical repair, evaluation, or acute management) to support the “A” 7th character. A note documenting only patient progress without new treatment intervention aligns with “D.”
• Provider signature and credentials: The note must be authenticated by a licensed provider with appropriate credentials for the clinical setting.

The ICD-10-CM Official Guidelines, approved by CMS, NCHS, the AHA and AHIMA, bar coders from making clinical assumptions to raise code specificity. When documentation is ambiguous about laterality or injury type, a clinical query to the provider is required before the claim is submitted.

External cause codes to pair with S76.221A

The ICD-10-CM guidelines encourage external cause codes alongside injury codes, and some payers ask for them. There is no national mandate, so leaving them off rarely causes a denial on its own. Adding them records how the injury happened, which supports medical necessity.

External cause codes are sequenced after the primary injury code (S76.221A). Report the place (Y92), activity (Y93) and status (Y99) codes once, at the initial encounter. The mechanism code can be reported for the full course of treatment, with a 7th character that matches the injury code. Check each payer’s policy, since some commercial and workers’ compensation plans ask for activity and place codes on injury claims.

CPT codes commonly billed alongside S76.221A

S76.221A pairs with wound repair codes billed by the treating surgeon or ED provider at the initial encounter, then with rehabilitative codes in physical therapy. Once care moves into the healing phase, those therapy claims carry S76.221D instead. Medical necessity must be established in the clinical note for each CPT code billed.

Confirm CPT-to-ICD-10 crosswalk compatibility with individual payer LCDs before billing. Requirements vary by Medicare Administrative Contractor and by commercial plan. Therapy codes such as CPT 97110 usually pair with S76.221D once care moves to rehabilitation, so confirm the 7th character before the crosswalk check.

Payer guidelines and prior authorization for S76.221A

Prior authorization requirements for services billed with S76.221A vary significantly by payer, plan, and region. No universal rule applies. The guidance below reflects general patterns, so verify with the specific payer before rendering service.

• Medicare: Physical therapy services for this injury count toward Medicare’s KX-modifier threshold for outpatient therapy and fall under related supervision rules. Prior authorization is not required for most outpatient PT visits, but documentation must demonstrate medical necessity per the applicable LCD. Confirm your MAC’s local coverage article for adductor and thigh muscle injuries.
• Commercial insurers: Many commercial plans require prior authorization for physical therapy beyond an initial evaluation, particularly if more than 6-8 visits are anticipated. Some plans apply visit limits without prior auth for the initial course. Verify the specific plan’s PT benefit and authorization threshold before the first appointment.
• Workers’ compensation: Prior authorization is almost universally required for WC claims. The employer’s carrier typically manages authorization. S76.221A must map to an approved treatment protocol and accepted body part.
• Medicaid: Requirements are state-specific. Some state Medicaid programs require prior authorization for all non-emergency PT; others allow a limited number of visits without auth. Check your state’s fee schedule and PA rules.

Completing insurance eligibility verification before each encounter catches benefit limits and authorization requirements early, which prevents retroactive denials.

Top reasons S76.221A claims are denied

Claim denials for S76.221A follow a predictable set of documentation and coding failures. Each one comes back with a reason code, and our guide to common denial codes explains how to read and fix them. Fixing the cause before submission is faster than working a denial queue.

Effective denial management in healthcare starts before the claim leaves the practice. Pre-bill coding audits, automated eligibility checks and clearinghouse claim scrubbing catch most of these errors before they reach the payer. For practices that bill electronically, submitting a clean claim the first time saves a resubmission cycle on every claim.

Coding scenarios: How to apply S76.221A in practice

Step-by-step code selection logic helps coders apply S76.221A correctly across the most common clinical presentations. The three scenarios below cover the situations where coders most frequently make errors.

Scenario 1: Deep thigh wound from a fall onto sharp equipment

A 24-year-old soccer player falls onto the sharp metal edge of a portable goal frame during a game. Exploration in the emergency department finds a deep right inner-thigh laceration that extends through the fascia into the adductor muscle. The surgeon performs a layered repair and documents “laceration of right adductor muscle and fascia.”

• Primary code: S76.221A – confirmed right side, documented laceration, active treatment with surgical repair
• Open wound: S71.111A (laceration without foreign body, right thigh), coded as the S76 category instructs
• Mechanism: W26.8XXA (contact with other sharp object, not elsewhere classified), since the goal frame’s sharp edge caused the wound
• Activity: Y93.66 (activity, soccer)
• Place of occurrence: Y92.322 (soccer field)
• 7th character reasoning: “A” – this is the initial active treatment encounter

Scenario 2: Week 4 physical therapy follow-up

The same patient returns to physical therapy four weeks after the repair for adductor strengthening and gait training. The PT note documents progress and ongoing therapeutic exercise. No new injury or acute intervention is recorded.

• Primary code: S76.221D – healing phase, routine rehabilitation
• External cause: Report the mechanism code with a D 7th character. Do not repeat the Y92, Y93 or Y99 codes.
• Common error to avoid: Continuing to bill S76.221A at week 4 because it was used at the initial visit

Scenario 3: Laterality unclear in the note

A provider documents “laceration, adductor muscle, thigh” with no side specified. The triage note mentions a wound on the right inner thigh, but the clinical note does not confirm the side.

• Do not assign: S76.221A – laterality is not documented in the clinical note
• Correct action: Issue a clinical query to the provider requesting laterality confirmation before coding
• Interim code: S76.221A cannot be used as a placeholder. Hold the claim until the provider responds.

The CMS ICD-10 coding guidelines are clear that coders must not make assumptions about clinical information not stated in the documentation. A clinical query is always the right step when documentation is ambiguous about a code-defining element like laterality.

How claims management software keeps S76.221A claims clean

In many practices, the coder reads the note in one system and keys the claim into another. That handoff is where the side, the injury type or the 7th character slips. A strain charted as a laceration, or an “A” carried into week four, only surfaces when the denial comes back.

Pabau, the practice management platform we build, keeps the clinical note, the diagnosis code and the claim in one patient record. With claims software for coders, the coder checks laterality and encounter stage against the note before the claim goes out. Eligibility checks and electronic submission through a clearinghouse run from the same screen.

The result is fewer claims bouncing back for a wrong side or a stale 7th character. Your team spends less time reworking adductor laceration claims and more time on the next encounter.

Catch laterality and 7th character errors before billing

Pabau’s claims management software keeps the diagnosis code, the clinical note and the claim in one record. Your team can check side, injury type and encounter stage before a claim goes out.

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Conclusion

S76.221A has to be earned from the note. If the chart cannot tell you the side, the wound depth and the stage of care, send a query before you bill. A held claim costs a day, while a denied one costs a resubmission and an appeal.

The bigger shift comes once the encounter moves to rehabilitation. Switching every follow-up claim to S76.221D, and dropping the one-time Y92, Y93 and Y99 codes, keeps the episode consistent from first visit to discharge. Book a demo to see how Pabau keeps the code and the clinical note aligned at every visit.

Continue your research

Need to understand denial patterns before they hit your revenue? Denial management in healthcare explains the most common claim rejection types and how to build a pre-bill audit process that catches them.

Billing physical therapy services and need clean claim guidance? Submitting a clean claim covers the essential elements every PT and sports medicine claim must include to clear payer edits on the first pass.

Want to verify patient benefits before the first appointment? Insurance eligibility verification walks through how real-time eligibility checks prevent retroactive denials and authorization surprises.

Coding the repair of a deep thigh laceration? CPT code 12032 covers intermediate wound repair, including length rules and documentation for layered closures.

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