Wiki Dx T76.12 for suspected child abuse

[ni11235813]

There is some disagreement in our office about whether dx T76.12 for suspected child abuse that has not yet been confirmed is an acceptable dx for an office visit.

The 5 y.o. child presented for a preventive visit in the company of his aunt. The provider documented details given by the aunt regarding child abuse perpetrated by the patient’s mother. The provider also documented the case number of the report made to CPS.

Based on these observations, I believe dx T76.12XA is appropriate. However, other coders in the office believe dx T76.12XA cannot be reported due the wording “suspected” child abuse. The POS for this visit is 50 for a FQHC clinic. I mention this because I do know dx from Z03 should only be reported in POS 22. (Or perhaps I’m wrong here too!)

Can anyone provide a definitive reference to confirm whether or not dx T76.12XA can be coded for this scenario?

Thank you!

 

[thomas7331]

First of all, there are no restrictions on the use of this code (or any code for that matter) just to certain places of service, so it's fine to use this for an office visit if that code best reports what is documented. Z03 is not just for POS 22 - not sure where you've heard that - but that code is incorrect for the situation you describe.

Guidance on coding of suspected or confirmed abuse is addressed in detail in the ICD-10 guidelines, I.C.19.f. - it may be useful to review this section with the coders in your office. It's quite clear in the guidelines that a documented case of suspected abuse would be coded from the T76.- category unless it is ruled out at that encounter, in which case it would be coded Z04.7- (not Z03). I agree with your choice of T76.12XA - if the provider is filing a case, then it almost certainly has not been ruled out.

I'm not sure I understand the rationale your coders are giving for not using T76.12XA for a suspected case, because that's exactly what this code is intended to report. They are perhaps applying the outpatient guidance for reporting signs and symptoms when a definitive diagnosis has not yet been confirmed, but that does not apply to this situation because there is a code available specifically for the purpose of reporting suspected abuse.