ICD-10 Coding for Assault by Person(T74.11XA, Y04.0XXA)
Complete ICD-10-CM coding and documentation guide for Assault by Person. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Assault by Person
T74.11-T74.12Primary Range
Adult and child abuse, confirmed
Used for confirmed cases of physical abuse by another person.
Encounter for examination and observation following alleged adult physical abuse
Used for suspected abuse cases requiring examination.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| T74.11XA | Adult physical abuse, confirmed, initial encounter | Use when abuse is confirmed by a healthcare provider. |
|
| Y04.0XXA | Assault by unarmed fight or brawl, initial encounter | Use when the assault involves an unarmed fight. |
|
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 assault by person
Essential facts and insights about Assault by Person
Primary ICD-10-CM Codes for assault by person
Decision Criteria
clinical Criteria
- Confirmed abuse by healthcare provider
Applicable To
- Confirmed physical abuse by spouse or partner
Excludes
- Suspected abuse (use Z04.71)
Clinical Validation Requirements
- Physician documentation confirming abuse
- Injury consistent with abuse patterns
Code-Specific Risks
- Misclassification if abuse is not confirmed
Coding Notes
- Ensure documentation explicitly states 'confirmed' abuse.
Y04.0XXA - Assault by unarmed fight or brawl, initial encounter
Use when the assault involves an unarmed fight.
Applicable To
- Assault by fist fight
Excludes
- Assault by firearm (use X93-X95)
Clinical Validation Requirements
- Documentation of fight or brawl
- No weapons involved
Coding Notes
Ensure documentation specifies 'unarmed' fight.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Perpetrator of maltreatment and neglect
Y07.-Differential 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 Assault by Person to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code T74.11XA.
Impact
Clinical: Incomplete patient history, Regulatory: Potential audit issues, Financial: Denied claims due to incomplete coding
Mitigation Strategy
Always document perpetrator details when known, Use Y07.- codes appropriately
Impact
Reimbursement: Incorrect coding may lead to denied claims., Compliance: Non-compliance with ICD-10 guidelines., Data Quality: Inaccurate data on abuse cases.
Mitigation Strategy
Use T74.11XA for confirmed cases, not Z04.71.
Impact
Using Z04.71 for confirmed abuse cases can lead to audit flags.
Mitigation Strategy
Ensure abuse is confirmed before using T74.11XA.
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 Assault by Person, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Assault by Person
Use these documentation templates to ensure complete and accurate documentation for Assault by Person. These templates include all required elements for proper coding and billing.
Emergency Department Visit for Assault
Specialty: Emergency MedicineRequired Elements
- Mechanism of injury
- Perpetrator details
- Injury description
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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