Wiki coding child abuse

fatielara

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child's mom had concern the child is being sexually abuse, the doctor did an exam and told me to code the case as 995.53 as child sexual abuse , she said it was suspected it was fine to use 995.53, I disagree and wanted to use
v71.81 for observation and eval. Doc says she was plenty experience with the insurance telling her she is correct in using the 995.53. how does anyone else's office's code their cases in these situations?
 
child's mom had concern the child is being sexually abuse, the doctor did an exam and told me to code the case as 995.53 as child sexual abuse , she said it was suspected it was fine to use 995.53, I disagree and wanted to use
v71.81 for observation and eval. Doc says she was plenty experience with the insurance telling her she is correct in using the 995.53. how does anyone else's office's code their cases in these situations?

suspected child abuse is not coded with 995.53, this would be confirmed on exam and needs External cause codes for the perpetrator and nature of abuse. the V71 codes are for suspected but not found on exam. so it really comes down to how it was documented.
 
she did an exam and nothing was found, this is what she responded with,

Although my notes says ?concerning for child sexual abuse?, they need to be billed with the child sexual abuse code which I selected. Just FYI to you all regarding the language. I cannot say ?most consistent with? in these cases but it is ok to go ahead and code as child sexual abuse as this was an evaluation for it.

she wants to code all future cases this way also, even my boss agreed with her but I do not.
 
We cannot code concerning for abuse as child sexual abuse. If the exam found nothing then a V71 code is the correct code. The V71.5 Observation following alleged rape or seduction, in the category for condition not found is much more accurate for the documentation, it too states the reason for the encounter. These are patient dx codes and if the patient does not have that condition documented then it cannot be used on the claim.
 
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she did an exam and nothing was found, this is what she responded with,

Although my notes says ?concerning for child sexual abuse?, they need to be billed with the child sexual abuse code which I selected. Just FYI to you all regarding the language. I cannot say ?most consistent with? in these cases but it is ok to go ahead and code as child sexual abuse as this was an evaluation for it.

she wants to code all future cases this way also, even my boss agreed with her but I do not.

Under HIPAA, physicians must report diagnosis codes according to the ICD guidelines and Coding Clinic guidance where applicable. Coding Clinic of March-April 1987 discussed the issues of suspected conditions ruled out and should be the guidance used in reporting these encounters. Of particular note are the following instructions.

"Patient's (or parent's) statement of rape or seduction and no findings by the examining physician of hemorrhage, laceration(s), or other physical trauma is classified to V71.5. Rape is not a medical diagnosis but a matter of jurisprudence and is, therefore, qualified by the term "alleged" in the title of V71.5. Code V71.5 includes the collection of any specimens, any advice on prophylaxis against pregnancy or venereal disease, and provision of (or for access to) counseling services. If the alleged rape victim is pregnant and there is no evidence of any pregnancy complications, code V22.2 is assigned as an additional code."

"The alleged rape, seduction, or sexual assault inflicted on a woman, child, or man with findings of hemorrhage, external or internal lacerations, and/or other physical or mental trauma is coded to the condition(s) diagnosed. An additional code for child abuse, 995.5, or adult abuse, 995.81, may be used to describe the impact of the injurious and stressful circumstances inflicted (such as humiliation, fear, confusion, and/or helplessness)."

(The 995.5 code was later expanded to include five digits.)

In ICD-10, guidelines instruct "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.-)." and "If a suspected case of alleged rape or sexual abuse is ruled out during an encounter code Z04.41, Encounter for examination and observation following alleged physical adult abuse, ruled out, or code Z04.42, Encounter for examination and observation following alleged rape or sexual abuse, ruled out, should be used, not a code from T76."

I hope this helps.
 
this is directly from the 2023 ECD-10 guidelines:

f. Adult and child abuse, neglect and other maltreatment
Sequence first the appropriate code from categories T74, Adult and child abuse, neglect and other maltreatment, confirmed, or T76, Adult and child abuse, ICD-10-CM Official Guidelines for Coding andReporting FY 2023 Page 83 of 118 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.

If a suspected case of abuse, neglect or mistreatment is ruled out during an encounter code Z04.71, Encounter for examination and observation following alleged physical adult abuse, ruled out, or code Z04.72, Encounter for examination and observation following alleged child physical abuse, ruled out, should be used, not a code from T76.

If a suspected case of alleged rape or sexual abuse is ruled out during an encounter code Z04.41, Encounter for examination and observation following alleged adult rape or code Z04.42, Encounter for examination and observation following alleged child rape, should be used, not a code from T76.

If a suspected case of forced sexual exploitation or forced labor exploitation is ruled out during an encounter, code Z04.81, Encounter for examination and observation of victim following forced sexual exploitation, or code Z04.82, Encounter for examination and observation of victim following forced labor exploitation, should be used, not a code from T76.
 
Ok I have two questions bc I ran into a similar situation.
1. Is the March 1987 coding clinic still applicable even though it referred to the ICD-9 standards??is there a way to look up which coding clinics are no longer applicable to present day?( I'm new at this obviously).
2. Under the icd-10 standards can a Nurse practitioner assigns an icd-10 of t74(confirmed child sexual abuse) with normal ano-genital exam and 1 verbal report of abuse from a child in the presence of her mother but during a forensic interview away from her mom the child changes her account of the events that she wasn't abused? To me, it seems she shouldn't bc of conflicting info. Also, the parents are in the middle of an ugly custody battle. Ugh so confusing. Please advise.

I can't answer the question about coding, but I can answer the question about Coding Clinic.

Coding Clinic guidance is valid unless superseded by new guidance, even if it is an older reference. Many of the coding books will note next to a code if there are applicable references in Coding Clinic.

In my 2023 ICD-10-CM manual, there are notations by some of the codes under T74.- and T76.- that refer to AHA: 2018, 4Q, 32-33, 65. That 2018 update likely superseded the 1987 information that probably was current when this thread was created in 2015.

A subscription is needed to look up past issues of Coding Clinic. I used to have access through a former employer and I loved it - there's a wealth of information!

I don't have access through my current employer. (I don't necessarily "need" it for my current position.) Sometimes I'm tempted to bite the bullet and pay for my own subscription, just for my own personal use. Alas, with 2 kids in college right now, I've been holding off on taking on another expense.
 
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