ICD-10 Guide

Hamstring Tear

ICD-10 Coding for Hamstring Tear(S76.311A, S76.312A)

PRIMARY SPECIALTYOrthopedics

COMPLEXITYHigh

LAST UPDATED09/15/2025

Sam Tuffun, PT, DPT

Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Hamstring Tear?

Essential facts and insights about Hamstring Tear

Key Clinical Considerations:

Sudden pain in the back of the thigh
Swelling and bruising in the affected area
Difficulty walking or straightening the leg

Clinical Information

Clinical Criteria & Documentation Requirements

Patient history of injury mechanism
Description of pain severity and location
Results of imaging studies (MRI, ultrasound)

Coding Guidelines

Usage Guidelines & Examples

Follow guidelines for coding severity of the tear (mild, moderate, severe)
Common errors include misclassifying the injury type or location

Code Exclusions

Important Exclusions

Complete muscle tears, other thigh injuries
Alternative codes for related conditions like contusions

Specialty Focus

Primary Specialty

Orthopedics

Specialty Applications

Athletes, active individuals, older adults
Emergency departments, outpatient orthopedic clinics

Coding Complexity

High Complexity

This diagnosis requires careful attention to:

Comprehensive clinical documentation
Accurate code selection based on clinical criteria
Proper exclusion considerations
Specialty-specific coding guidelines

Documentation

Documentation Templates

Billing Information

Billing Considerations

Ensure proper documentation for billing
Verify code specificity requirements
Check for any additional codes needed
Review payer-specific guidelines

Common Issues

Insufficient clinical documentation
Incorrect code selection
Missing supporting diagnoses
Timing and frequency documentation

Frequently Asked Questions

What are the documentation requirements?

Document the mechanism of injury, symptoms, and physical exam findings.

What are the billing considerations?

Ensure accurate coding to reflect the severity and location of the tear.

Hamstring Tear

Diagnosis Overview

Key Clinical Considerations:

Clinical Information

Clinical Criteria & Documentation Requirements

Coding Guidelines

Usage Guidelines & Examples

Code Exclusions

Important Exclusions

Related ICD-10 Codes

Related CPT Codes

Specialty Focus

Primary Specialty

Specialty Applications

Coding Complexity

Documentation

Documentation Templates

Billing Information

Billing Considerations

Common Issues

Frequently Asked Questions

What are the documentation requirements?

What are the billing considerations?

Hamstring Tear

Diagnosis Overview

Key Clinical Considerations:

Clinical Information

Clinical Criteria & Documentation Requirements

Coding Guidelines

Usage Guidelines & Examples

Code Exclusions

Important Exclusions

Related ICD-10 Codes

Related CPT Codes

Specialty Focus

Primary Specialty

Specialty Applications

Coding Complexity

Documentation

Documentation Templates

Billing Information

Billing Considerations

Common Issues

Frequently Asked Questions

What are the documentation requirements?

What are the billing considerations?