With the April 1st update to ICD-10-CM, some changes came for coding abuse. This installment of “In the kNOW” will address these changes. However, it is worthwhile to review the official guidance related to coding for abuse as well.
Since abuse is classified as an injury in ICD-10-CM, applicable codes will be found in Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes. These abuse codes are indexed under the term “Maltreatment” which includes all forms of abuse (abandonment, bullying, intimidation, neglect, or financial, physical, psychological, or sexual abuse). Let’s look at guideline I.C.19.f Adult and child abuse, neglect and other maltreatment. This guideline tells coding professionals how to determine “confirmed” or “suspected” abuse.
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).
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.-).
For cases of confirmed abuse or neglect an external cause code from the assault section (X92-Y09) should be added to identify the cause of any physical injuries. A perpetrator code (Y07) should be added when the perpetrator of the abuse is known. For suspected cases of abuse or neglect, do not report external cause or perpetrator code.
You’ll also note that the guideline gives clear direction that when coding confirmed cases of abuse it will also be necessary to assign the appropriate external cause code and the perpetrator when known.
Six new codes were added to the abuse category:
T74.3 Psychological abuse, confirmed
T76.3 Psychological abuse, suspected
T74.A1 Adult financial abuse, confirmed
T74.A2 Child financial abuse, confirmed
T76.A1 Adult financial abuse, suspected
T76.A2 Child financial abuse, suspected
The next applicable guideline is I.C.20.f Multiple External Cause Coding Guidelines. Here coding professionals are directed to assign the external cause codes for adult or child abuse before any other external cause codes are listed.
More than one external cause code is required to fully describe the external cause of an illness or injury. The assignment of external cause codes should be sequenced in the following priority:
If two or more events cause separate injuries, an external cause code should be assigned for each cause. The first-listed external cause code will be selected in the following order:
External codes for child and adult abuse take priority over all other external cause codes.
The final guideline that applies to coding for abuse is I.C.20.g. Child and Adult Abuse Guideline. This guideline states that ICD-10-CM classifies adult and child abuse as an assault. It also provides a directive that when the perpetrator of the abuse is known a Y07 code should be assigned.
Adult and child abuse, neglect and maltreatment are classified as assault. Any of the assault codes may be used to indicate the external cause of any injury resulting from the confirmed abuse.
For confirmed cases of abuse, neglect and maltreatment, when the perpetrator is known, a code from Y07, Perpetrator of maltreatment and neglect, should accompany any other assault codes.
Speaking of the Y07 category, this series of codes underwent expansion with the April code update. Now, when identifying the perpetrator as husband, wife, or partner, there are codes that will allow you to capture if these individuals are current or former spouses or partners. When coding for child or grandchild as the perpetrator, the respective codes Y07.44 and Y07.45 apply if the person is related biologically, adopted, foster, step, or in-law. There are also codes to capture grandparents, parental sibling, and acquaintances or friends as the abuse perpetrator.
Coding professionals will be able to find Y07 Perpetrator of assault, maltreatment and neglect codes in the External Cause Index under the main entry “Perpetrator”. At the beginning of the Tabular List there are two notes posted:
1. Codes from this category are for use only in cases of confirmed abuse (T74.-).
2. Selection of the correct perpetrator code is based on the relationship between the perpetrator and the victim.
The first is simply a reminder of a guideline and the second provides context for determining the perpetrator.
Now you are In the kNOW!!
Dianna Foley, RHIA, CCS, CHPS, CDIP is
OHIMA's Education Coordinator. Dianna has been an HIM
professional for over 20 years. She progressed through the ranks of coder,
department supervisor, and department director, to her current role as a
coding consultant. She previously served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati and holds RHIA, CHPS, CDIP and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and is a presenter on coding topics at the national, state, and regional levels. Dianna mentors new AHIMA members and also provides monthly educational lectures to coders and clinical documentation specialists.
