snwhite0730
Contributor
I work at an IP mental health hospital and need some clarification on when and how to use the sequela code for abuse.
We had a patient who is an adult now but suffered sexual abuse as a child, he now has PTSD and other mental health dx from that abuse. Reading the guidelines it didn't seem appropriate to code adult abuse as this took place when he was a child and using history also didn't seem appropriate since he is currently in treatment directly related to the abuse he suffered as a child. I coded PTSD followed by the child abuse confirmed T74.22XS with the appropriate Y07 codes for the perpetrator. Our encoder gave an alert that based on the age of the patient the code wasn't valid but as stated above it didn't seem appropriate to use adult. The claim was denied by his insurance.
I submitted this scenario to AHA coding clinic who also stated that the code use is based on when the abuse took place regardless of the age of the patient. Our corporate RHIT has now escalated this since there are others stating it is better to use the history of abuse code to ensure payment from insurance. Is there anyone who can give a little more guidance on proper reporting using these codes? The 7th character sequelae seems more than appropriate in this case, it's the age of the code used that is making this harder to code and fight the insurance. Any help or guidance is greatly appreciated!
We had a patient who is an adult now but suffered sexual abuse as a child, he now has PTSD and other mental health dx from that abuse. Reading the guidelines it didn't seem appropriate to code adult abuse as this took place when he was a child and using history also didn't seem appropriate since he is currently in treatment directly related to the abuse he suffered as a child. I coded PTSD followed by the child abuse confirmed T74.22XS with the appropriate Y07 codes for the perpetrator. Our encoder gave an alert that based on the age of the patient the code wasn't valid but as stated above it didn't seem appropriate to use adult. The claim was denied by his insurance.
I submitted this scenario to AHA coding clinic who also stated that the code use is based on when the abuse took place regardless of the age of the patient. Our corporate RHIT has now escalated this since there are others stating it is better to use the history of abuse code to ensure payment from insurance. Is there anyone who can give a little more guidance on proper reporting using these codes? The 7th character sequelae seems more than appropriate in this case, it's the age of the code used that is making this harder to code and fight the insurance. Any help or guidance is greatly appreciated!