ICD-10 Coding for Altercation(Y04.0XXA, T74.11XA)
Complete ICD-10-CM coding and documentation guide for Altercation. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Altercation
Y04.0XXAPrimary Range
Assault by unarmed brawl or fight
Primary code for documenting unarmed physical altercations without confirmed abuse.
Injury, poisoning and certain other consequences of external causes
Used to code specific injuries resulting from altercations.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| Y04.0XXA | Assault by unarmed brawl or fight, initial encounter | Use for mutual unarmed altercations without confirmed abuse. |
|
| T74.11XA | Adult physical abuse, confirmed, initial encounter | Use when altercation is confirmed as abuse. |
|
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 unarmed altercation
Essential facts and insights about Altercation
Primary ICD-10-CM Codes for altercation
Decision Criteria
clinical Criteria
- Mutual combat with no weapons
coding Criteria
- No evidence of abuse
documentation Criteria
- Detailed account of altercation
Applicable To
- Mutual combat
- Unarmed physical altercation
Clinical Validation Requirements
- Documentation of mutual combat
- No weapons involved
- Injury consistent with blunt force trauma
Code-Specific Risks
- Misclassification as abuse
- Omission of injury codes
Coding Notes
- Ensure documentation specifies mutuality and absence of weapons.
T74.11XA - Adult physical abuse, confirmed, initial encounter
Use when altercation is confirmed as abuse.
Applicable To
- Confirmed physical abuse
Excludes
- Mutual combat (Y04.0XXA)
Clinical Validation Requirements
- Provider documentation of abuse
- Evidence of intentional harm
Coding Notes
Ensure abuse is confirmed and documented.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Altercation to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code Y04.0XXA.
Impact
Clinical: Inadequate injury assessment, Regulatory: Non-compliance with documentation standards, Financial: Potential claim denial
Mitigation Strategy
Use specific terms like 'mutual unarmed altercation', Document injury details
Impact
Reimbursement: Incorrect DRG assignment, Compliance: Non-compliance with coding guidelines, Data Quality: Inaccurate abuse statistics
Mitigation Strategy
Use T74.11XA for confirmed abuse.
Impact
Reimbursement: Potential claim denial, Compliance: Non-compliance with ICD-10 requirements, Data Quality: Incomplete encounter data
Mitigation Strategy
Include 7th character (A/D/S) for encounter type.
Impact
Using Y04.0XXA for confirmed abuse can lead to audits.
Mitigation Strategy
Verify abuse status and use appropriate codes.
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 Altercation, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Altercation
Use these documentation templates to ensure complete and accurate documentation for Altercation. These templates include all required elements for proper coding and billing.
Emergency Department Visit for Altercation
Specialty: Emergency MedicineRequired Elements
- Mechanism of injury
- Injury details
- Location of incident
- Involvement of weapons
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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