General Surgery Coding Alert

Reader Question:

Look for Signs of Abuse

Published on Mon Jul 26, 2004

Question: What are some of the signs of physical, sexual and/or emotional abuse in a child?

North Carolina Subscriber

Answer: There are several signs and symptoms to look for in children who may be the subject of abuse. Look for the following for physical abuse:

Unexplained injuries, such as burns (e.g., 943.21, Burn of upper limb, except wrist and hand; blisters, epidermal loss [second degree]; forearm), bites (e.g., 882.0, Open wound of hand except finger[s] alone; without mention of complication), bruises (e.g., 922.31, Contusion of trunk; back), broken bones (e.g., 821.01, Fracture of other and unspecified parts of femur; shaft or unspecified part, closed; shaft) and black eyes (921.0, Black eye, not otherwise specified)

Healing bruises or contusions (especially after an absence from school)

Frightened of parents (V71.81, Observation and evaluation for other specified suspected conditions; abuse and neglect)

Objects when it's time to go home (V71.81)

Cowers at the approach of adults (V71.81).

For emotional abuse, some telltale signs include:

Shows behavioral extremes, such as being overly compliant or demanding, extreme passivity, or aggression (V71.81)

Inappropriately adult or child-like (V71.81)

Delayed physical or emotional development

Attempted suicide

Lack of attachment to the parent(s) (V71.81).

In the case of sexual abuse, look for the following:

Nonspecific symptoms, such as sleep disturbances (e.g., 780.50, Sleep disturbance, unspecified), nightmares, phobias, abdominal pain (e.g., 789.0x, Abdominal pain), sudden change in appetite, difficulty walking or sitting, or refuses to change for gym or participate in physical activities (V71.81)

Developmentally unusual sexual behavior (V71.81)

Rectal (569.3) or genital (623.8) bleeding

Contracts a sexually transmitted disease (e.g., 098.0, Gonococcal infections; acute, of lower genitourinary tract)

Becomes pregnant.