September 15, 2014

ICD-10 Brings Value to Injury Data Like Domestic Violence

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The international classification system for diseases in the United States is used for all general epidemiological, public health surveillance, reimbursement, and many health management purposes and for quality and outcomes use.

 

Chapter 20 of the International Classification of Diseases, tenth revision, clinical modification (ICD-10-CM) allows for the reporting of external causes of morbidity and mortality. Codes from Chapter 20 are used for information as to the external cause of the injury, poisoning and certain other consequences (S00-T88 codes).

Today we are capturing information on conditions and/or injuries resulting from domestic violence (DV) in ICD-9-CM (International Classification of Diseases, ninth revision, clinical modification) under Adult Maltreatment and Abuse (995.8_). See the following list of codes that are available:

995.81: physically abused person, battered person, spouse or woman

      995.82: adult emotional/psychological abuse

      995.83: adult sexual abuse

      995.84: adult neglect (nutritional)

      995.85: other adult abuse and neglect (multiple forms)

Within Chapter 20 of ICD-10-CM one will now find many codes are provided to clinically capture the domestic violence and/or abuse, both confirmed and unconfirmed. The three-character category T74 is Adult and child abuse, neglect and other maltreatment, confirmed. Here you will also see an instructional note:

  • to use an additional code if applicable, to identify any associated current injury

And use an

  • external cause code to identify perpetrator, if known (Y07.-)

The ICD-10-CM code ranges for confirmed domestic violence diagnoses are:

T74.01xA - T74.02xS: Neglect or abandonment, confirmed

T74.11xA - T74.12xS: Physical abuse, confirmed

T74.21xA - T74.22xS: Sexual abuse, confirmed

T74.31xA - T74.32xS: Psychological abuse, confirmed

T74.4xxA - T74.4xxS: Shaken infant syndrome

T74.91xA - T74.92xS: Unspecified maltreatment, confirmed

In addition, the encounter type is also going to be captured in ICD-10-CM, as the following examples indicate:

T74 Adult and child abuse, neglect and other maltreatment, confirmed

T74.1 Physical abuse, confirmed

T74.11 Adult physical abuse, confirmed

T74.11XA …… initial encounter

T74.11XD …… subsequent encounter

T74.11XS …… sequela

T74.12 Child physical abuse, confirmed

T74.12XA …… initial encounter

T74.12XD …… subsequent encounter

T74.12XS …… sequela

In ICD-10-CM Chapter 20 is the three-character code category T76 for Adult and child abuse, neglect and other maltreatment, suspected. Again there is an instructional note:

  • to use an additional code if applicable, to identify any associated current injury code        

The detailed ICD-10-CM code series for suspected domestic violence are as follows:

                  T76.01xA - T76.02xS: Neglect or abandonment, suspected

                  T76.11xA - T76.12xS: Physical abuse, suspected

                  T76.21xA - T76.22xS: Sexual abuse, suspected

                  T76.31xA - T76.32xS: Psychological abuse, suspected

                  T76.91xA - T76.92xS: Unspecified maltreatment, suspected

Each code in this series of DV codes will again delineate the type of encounter through the additional characters in the code that does not occur in ICD-9-CM:

  • initial encounter
  • subsequent encounter
  • sequela

For example:

T76.1 Physical abuse, suspected

T76.11 Adult physical abuse, suspected

T76.11XA …… initial encounter

T76.11XD …… subsequent encounter

T76.11XS …… sequela

T76.12 Child physical abuse, suspected

T76.12XA …… initial encounter

T76.12XD …… subsequent encounter

T76.12XS …… sequela

Within ICD-10-CM there are also helpful subcategories to capture more details in these specific abuse categories:

  • Adult Maltreatment
  • Battered Person
  • Adult Psychological Abuse
  • Adult Sexual Abuse
  • Adult Neglect

When you compare the ICD-9-CM 995.8_ series of codes to ICD-10-CM DV codes, they are clearly further classified within T74 for confirmed abuse and T76 unconfirmed or suspected abuse, and for the encounter type as seen in the following suspected DV, which is an advantage:

  • Suspected DV:

Adult maltreatment ICD-9-CM code = 995.8

ICD-10-CM =  T74.91xA Unspecified adult maltreatment, confirmed, initial encounter

T74.91xD Unspecified adult maltreatment, confirmed, subsequent encounter

T76.91xA Unspecified adult maltreatment, suspected, initial encounter

T76.91xD Unspecified adult maltreatment, suspected, subsequent encounter

T76.92XS Unspecified adult maltreatment, suspected, sequela encounter

We can’t discuss coding without discussing documentation. The coded data is only as good as the documentation in the medical record. A well-documented patient encounter should at least contain the following:

1. Detail the reason for the visit, chief complaint

2. Description of the symptoms or problems (if any) that prompted the visit

3. Description of the related health issues the patient is experiencing

4. Summary of the patient’s overall health history, social, and family history

5. Record of relevant findings from the physical exam

6. Record of results of laboratory and other diagnostic procedures

7. Record of options discussed with patients and referrals offered

8. Documentation of the arrangements made for follow-up care

There is a growing concern with domestic violence here in the United States. Looking back at some data, we find that according to the Bureau of Justice Statistics Crime Data Brief, Intimate Partner Violence, 1993-2001, February 2003 report, 85 percent of domestic violence victims are women.

The financial impact of domestic violence is also noteworthy. The data from a 2003 report, titled “Costs of Intimate Partner Violence Against Women in the United States,” from the Centers for Disease Control and Prevention National Centers for Injury Prevention and Control in Atlanta, GA., found that the cost of intimate partner violence exceeds $5.8 billion each year, $4.1 billion of which is for direct medical and mental health services.

There is a very useful presentation, titled: “A Comparison of ICD-10-CM and ICD-9-CM for Capturing Domestic Violence,” presented by Felicia Cohn, PhD; William Rudman, PhD; Travis Bankhead, BS; and Valerie Watzlaf, PhD, FAHIMA, RHIA, available through the American Health Information Management Foundation, which examines how ICD-10 is better at identifying domestic violence victims than with ICD-9 codes, and this echoes the need for the ICD-10 code set adoption.

With the addition of ICD-10-CM codes for DV as well as the enhanced specificity of codes, healthcare professionals should be better able to track the occurrences and treatment of DV. This new coded data can lead to helping victims, practitioners, and researchers in the detection, treatment, and prevention of domestic violence, which we all want.

This discussion of ICD-10-CM and domestic violence coding demonstrates once again that supporting ICD-10 for implementation on October 1, 2015, is the right thing to do.

References: Bureau of Justice Statistics Crime Data Brief, Intimate Partner Violence, 1993-2001, February 2003; Costs of Intimate Partner Violence Against Women in the United States; http://www.cdc.gov/violenceprevention/intimatepartnerviolence/datasources.html; http://ahimafoundation.org/downloads/pdfs/FVPF_domesticviolencepres.pdf; http://www.futureswithoutviolence.org/userfiles/file/HealthCare/codingpaper.pdf
http://www.icd10data.com/ICD10CM/Codes/S00-T88/T66-T78

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Gloryanne Bryant, RHIA, CDIP, CCS, CCDS, AHIMA-Approved ICD-10-CM/PCS Trainer

Gloryanne is a coding and HIM professional with 40 years of experience. She is the past president of the California Health Information Association. Gloryanne is a member of the ICD10monitor editor board and is a popular guest on Talk Ten Tuesdays.