ICD-10 Coding for Child Abuse and Neglect(T74.12XA, T76.12XA)
Complete ICD-10-CM coding and documentation guide for Child Abuse and Neglect. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Child Abuse and Neglect
T74-T76Primary Range
Adult and child abuse, neglect and other maltreatment, confirmed or suspected
This range includes codes for confirmed and suspected cases of abuse and neglect, which are crucial for accurate documentation and coding.
Assault mechanisms
These codes are used to specify the external cause of injuries in confirmed abuse cases.
Perpetrator of maltreatment and neglect
These codes identify the perpetrator in confirmed cases of abuse.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| T74.12XA | Child physical abuse, confirmed, initial encounter | Use when physical abuse is confirmed by authorities or medical evaluation. |
|
| T76.12XA | Child physical abuse, suspected, initial encounter | Use when abuse is suspected but not yet confirmed. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for confirmed child abuse
Essential facts and insights about Child Abuse and Neglect
Primary ICD-10-CM Codes for administration for child services
Decision Criteria
clinical Criteria
- Confirmed abuse by CPS or medical evaluation
coding Criteria
- Sequence T74.12XA before injury codes
Applicable To
- Confirmed physical abuse of child
Excludes
- Suspected child abuse (T76.12XA)
Clinical Validation Requirements
- CPS determination of abuse
- Multidisciplinary team consensus
Code-Specific Risks
- Incorrect sequencing with injury codes
- Omission of external cause codes
Coding Notes
- Ensure proper sequencing with T74 codes first, followed by injury and external cause codes.
T76.12XA - Child physical abuse, suspected, initial encounter
Use when abuse is suspected but not yet confirmed.
Applicable To
- Suspected physical abuse of child
Excludes
- Confirmed child abuse (T74.12XA)
Clinical Validation Requirements
- Documentation of suspicion pending investigation
Coding Notes
Ensure documentation supports suspicion and is updated if status changes.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Spiral fracture of humerus
S42.301ADifferential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Child Abuse and Neglect to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code T74.12XA.
Impact
Clinical: May lead to misdiagnosis or underreporting., Regulatory: Non-compliance with mandatory reporting laws., Financial: Potential claim denials due to insufficient documentation.
Mitigation Strategy
Use specific language linking injuries to abuse, Include CPS findings in documentation
Impact
Reimbursement: May lead to denied claims if sequencing is incorrect., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate data representation of abuse cases.
Mitigation Strategy
Always sequence T74/T76 codes before injury codes.
Impact
Risk of audits due to incorrect sequencing of T74/T76 codes.
Mitigation Strategy
Educate coders on proper sequencing rules.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Child Abuse and Neglect, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Child Abuse and Neglect
Use these documentation templates to ensure complete and accurate documentation for Child Abuse and Neglect. These templates include all required elements for proper coding and billing.
Confirmed Child Physical Abuse
Specialty: PediatricsRequired Elements
- Chief complaint in child's words
- History of injury mechanism
- CPS involvement
- Physical exam findings
- Assessment and plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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