However, further examination and questioning of the patient reveals that the boy had been involved in a particularly rough game of tackle football with his friends. Nevertheless, alcohol intoxication does not negate reports of sexual assault.
Then Follow the Guidelines The [], Make This Code Your First Choice in This Second-Degree Burn Scenario, Question: One of our patients recently received a second-degree burn to the palm of her [], Question: One of our teenage patients was involved in a car accident. Directions for future research include qualitative studies of providers rationale for their documentation and coding practices, evaluation of training programs intended to improve documentation, and use of telehealth to expand access to SANE programs. Before coding for any suspected or confirmed physical or sexual child abuse, you should become familiar with two different sets of ICD-10 guidelines, which are found in I.C.19.f. Full text available through open access at http://escholarship.org/uc/uciem_westjem. From a coding perspective, the distinction is significant as it affects subsequent code choices, as the guidelines go on to explain.
HCUP provides the hospital and discharge information necessary to calculate national estimates of ED visits, along with demographic information, reason for ED visit, and charge information. and I.C.20.g stipulate that an external cause code from the assault section (X92-Y09) should be added to identify the cause of any physical injuries. The sample is stratified by geographic region, trauma center designation, urban-rural location of the hospital, teaching hospitals, and hospital ownership. Extant data suggest that most sexual assaults against females occur prior to the age of 25.1 Furthermore, the age group of 1824 is referred to as emerging adults characterized by significant life transitions including college attendance and/or entry into the workforce in addition to increased experimentation and participation in unsafe behavior (ie, substance use).2325 As a result, this age demographic is particularly vulnerable to both violence and substance use.25 In recent years, sexual assault on college campuses has garnered significant national attention with increased media coverage and programming and services.26,27 Provider willingness to code cases with younger victims as sexual assault rather than adding the modifier alleged may reflect awareness of and empathy for these vulnerabilities. http://creativecommons.org/licenses/by/4.0/, https://www.cdc.gov/violenceprevention/pdf/sv_surveillance_definitionsl-2009-a.pdf, https://www.acep.org/globalassets/uploads/uploaded-files/acep/membership/sections-of-membership/forensic/sexual-assault-e-book2.pdf, www.hcup-us.ahrq.gov/db/nation/neds/NEDS_Introduction_2016.jsp, http://www.hcup-us.ahrq.gov/reports/methods/methods.jsp, https://ucr.fbi.gov/crime-in-the-u.s/2016/crime-in-the-u.s.-2016/topic-pages/tables/table-1, https://www.cdc.gov/violenceprevention/pdf/2015data-brief508.pdf. ]yW)4wkQHsaa{tG7J(DqHhh]Os"VXLx$:0+dU:tf+_J7K]4&d>IzneB"2JZNG6O\z5gAH_SJa3Ln7t~E'C92LPb'{MDMZ9y]k]ad4a0j.
Remember to Code for Episode of Care: Because suspected or confirmed physical or sexual child abuse are reported with codes from the Injury, Poisoning, and Certain Other Consequences of External Causes (S00-T88) chapter of ICD-10, you will need to make sure that you add both a placeholder, X, and the appropriate character for the episode of care to make up the seven character code. Odds ratios and confidence intervals in bold are significant (P < 0.05). Putting it All Together: Two Case Studies See: Basile KC, Smith SG.
Patients with the diagnostic code for alcohol use, unspecified (F10.9) were coded as having alcohol use. We conducted bivariate analyses to identify the prevalence of a diagnosis of confirmed sexual abuse or suspected sexual abuse among ED patients as well as provide descriptive statistics for these individuals. Health issues of women in rural environments: an overview. Uniform Crime Reporting Statistics. *Saint Louis University, School of Social Work, St. Louis, Missouri, Washington University School of Medicine, Division of Clinical and Translation Research, St. Louis, Missouri, Yonsei University, Graduate School of Social Welfare, Seoul, Republic of Korea, Wayne State University, School of Social Work, Detroit, Michigan, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, ||Saint Louis University School of Medicine, Division of Emergency Medicine, St. Louis, Missouri, Sexual assault is a public health problem that affects many Americans and has multiple long-lasting effects on victims. about navigating our updated article layout.
The
Additionally, a perpetrator code (Y07) should be added when the perpetrators identity is known. Women reporting intimate partner violence in India: associations with PTSD and depressive symptoms.
This means adding either A (Initial encounter), D (Subsequent encounter), or S (Sequela) to the code to indicate the progress of the patients treatment. Sexual violence surveillance: uniform definitions and recommended data elements. A.
Sexual assault is underreported. This study employed data from the 2016 Nationwide Emergency Department Sample (NEDS) of the Healthcare Cost Utilization Project (HCUP) distributed by the US Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ).1820 The NEDS includes data on approximately 33 million hospital-based ED visits from 953 hospitals approximating a 20% sample of US hospital-owned EDs. Kennedy KM. National Library of Medicine With respect to age, those with confirmed sexual abuse were more likely to be younger than 25 compared to any other age group. Before American Hospital Association ("AHA"), www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/resilience/Pages/Child-Abuse-and-Neglect.aspx, Condition Spotlight: Answer These 4 Questions to Master Food Allergy Coding, Clip and Save: Use This Chart to Code Common Winter Conditions, You Be the Coder: Clarify Payer Guidelines to Avoid This Coding Headache.
Empirically documented correlates of sexual victimization include young age, female gender, childhood history of maltreatment, and substance use/abuse.1 Approximately 20% of women and 2% of men experience rape at some point in their lives, accounting for an estimated 1.2 trillion dollars in direct medical costs and a total of 3.1 trillion dollars when lost productivity and other indirect costs are included (2014 US dollars).2,3 Despite the deleterious and long-lasting physical and mental health conditions associated with rape and sexual assault, most of these assaults are never reported.46 According to Kimerling, the under-reporting of sexual assault may be attributed to the private, intimate nature of the assault and pervasive negative social consequences to disclosure.7 While it is widely accepted that sexual assault and rape are under-reported, medical personnel, law enforcement, the legal system, and society are often skeptical when victims do come forward. Case Study 1: During an examination of a 10-year-old male patient, your pediatrician discovers extensive bruising around the childs buttocks and left thigh. Putting it All Together: Two Case Studies. Hashimoto RE, Brodt ED, Skelly AC, et al. And make sure your practice is prepared for the worst. An official website of the United States government. The https:// ensures that you are connecting to the A single dichotomous code was used to identify cases with a diagnosis of confirmed sexual abuse (ICD-10-CM code T74.21).
Remember to Code for Episode of Care: Because suspected or confirmed physical or sexual child abuse are reported with codes from the Injury, Poisoning, and Certain Other Consequences of External Causes (S00-T88) chapter of ICD-10, you will need to make sure that you add both a placeholder, X, and the appropriate character for the episode of care to make up the seven character code. Breiding MJ, Smith SG, Basile KC, et al. Thats because the observation Z codes are only for use when a person is being observed for a suspected condition that is ruled out, not for an injury, illness, or signs or symptoms related to the suspected condition.
The analyses were weighted to account for the NEDS complex sampling design using the svyset command and svy prefix in Stata 14.2 (StataCorp, College Station, TX). Rural EDs may ED identification of sexual assault has the potential to link victims to community services through referrals to counseling, victim advocates, and legal services services that have been empirically documented to improve psychological health and increase social support. tells you to code confirmed cases of abuse or neglect with T74.- (Adult and child abuse, neglect and other maltreatment, confirmed), while suspected child abuse or neglect would be coded with a code from T76.- (Adult and child abuse, neglect and other maltreatment, suspected).
Cases coded as confirmed sexual assault had slightly more CPT procedures than cases coded as alleged. In this case, Guideline 1.C.19.f comes into effect, and you would code T74.22XA(Child sexual abuse, confirmed, initial encounter). tells you to code confirmed cases of abuse or neglect with T74.- (Adult and child abuse, neglect and other maltreatment, confirmed), while suspected child abuse or neglect would be coded with a code from T76.- (Adult and child abuse, neglect and other maltreatment, suspected). Delayed help-seeking may affect victims abilities to have crucial forensic evidence collected (ie, SANE exam). Recent high-profile cases such as the Me Too movement and the outcry against lenient sentences imposed on perpetrators may have changed coding patterns. Additionally, alcohol intoxication may increase uncertainty regarding the events surrounding the assault.
Sexual assault is notoriously under-reported. Email: Received 2020 Jul 12; Accepted 2020 Oct 12. 
Sexual assault victims with a concurrent code for alcohol abuse were less likely to be coded as confirmed. There are no conflicts of interest or sources of funding to declare. 0000001421 00000 n
Crane J. Additionally, a perpetrator code (Y07) should be added when the perpetrators identity is known.
Thomas TL, Nobrega JC, Britton-Susino S. Rural health, forensic science and justice: A perspective of planning and implementation of a sexual assault nurse examiner training program to support victims of sexual assault in rural underserved areas. Medical evaluation after sexual assault frequently occurs in the emergency department, and documentation of the visit plays a significant role in decisions regarding prosecution and outcomes of legal cases against perpetrators. Sociodemographic associations with suspected versus confirmed sexual abuse in United States emergency departments in 2016. sharing sensitive information, make sure youre on a federal In addition, should your pediatrician eventually rule out the suspicion of neglect, abuse, mistreatment, rape, or exploitation, ICD-10 guidelines instruct you not to report a T76.- code at all. 0000002558 00000 n
Before you or anyone in your practice encounters a case of suspected or confirmed child physical or sexual abuse, the American Academy of Pediatrics (AAP) recommends that your practice has a protocol in place to respond that is consistent with legal reporting requirements,state-based statutes, and utilizes appropriate community resources. That includes knowing which authorities to contact and deciding on a safe place for the child when such an event occurs (Source: Protect Your 2020 Bottom Line With These 5 Steps, Dont let decreases in revenue for common peds services drag you down.
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Using the NEDS database, we estimated there were 24,627 ED visits for confirmed sexual abuse and 26,421 visits for suspected sexual abuse in 2016, a total of 51,048 ED visits.
Careers. And you will need to report the appropriate code from Z04.42 (Encounter for examination and observation following alleged child rape), Z04.72 (Encounter for examination and observation following alleged child physical abuse), or Z04.81 (Encounter for examination and observation of victim following forced sexual exploitation). Hospitals in large metropolitan areas with at least one million residents and those in small metropolitan areas were considered urban. In the same time period, there were 130,603 rapes reported to the Federal Bureau of Investigation.21 The most recent National Intimate Partner and Sexual Violence Survey estimated that 1,484,000 women are raped annually.22 In this context, we sought to determine factors that are associated with coding-confirmed sexual assault vs alleged sexual assault. Ethical dilemmas in coding domestic violence. With regard to hospital-level characteristics, individuals with confirmed sexual abuse are significantly more likely to admit to an urban hospital compared to one in a rural area (AOR, 1.59; 95% CI, 1.152.18). The new PMC design is here! Also, you would use Z04.42 as a secondary to the findings, suggests Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana. And make sure your practice is prepared for the worst. Case Study 1: During an examination of a 10-year-old male patient, your pediatrician discovers extensive bruising around the childs buttocks and left thigh. Sande MD, Broderick KB, Moreira ME, et al.
and I.C.20.g stipulate that an external cause code from the assault section (X92-Y09) should be added to identify the cause of any physical injuries. Teaching status or trauma level of the hospital was not significantly associated with suspected vs confirmed sexual abuse. We identified correlates to coding confirmed sexual assault but such associations cannot determine causality.
Your pediatrician examines the patient and confirms the patients allegations.
In this case, I would code S30.0XXA [, In this case, Guideline 1.C.19.f comes into effect, and you would code T74.22XA(, Additionally, I would code this with acode for any specific injury if documented in the chart and Y07.03 [.
Younger age, female gender, a larger number of procedure codes, urban hospital location, and lack of concurrent alcohol use are associated with coding for confirmed sexual assault. In 2016, there were approximately 26,421 adult discharges from EDs with a diagnostic code for suspected sexual abuse and 24,627 with confirmed sexual abuse. A single dichotomous code was used to identify cases with a diagnosis of suspected sexual abuse (T76.21). HCUP Nationwide Emergency Department Sample (NEDS).
Larsen ML, Hilden M, Lidegaard O.
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The hospitals urban-rural designation, trauma level, and teaching status were included in the analyses. Evaluation and Management of the Sexually Assaulted or Sexually Abused Patient. Rates of diagnostic testing and screening may vary across providers and/or institutions. Pro Coding Tip: Typically, the evaluation and management (E/M) code for these types of visits will be billed based on time due to the extensive counseling that will have to take place, along with referrals and police reports that will have to be filed, Holle recommends. Of course, the issue of child abuse goes beyond simply coding for the patients situation. Our study underscores the necessity of accessible, accurate, and efficient ways to document sexual assault in EDs. For suspected cases of abuse or neglect, the guidelines go on to instruct you not to report an external cause or perpetrator code.
Address for Correspondence: Cindy C. Bitter, MD, MPH, Saint Louis University School of Medicine, Division of Emergency Medicine, 1402 S Grand Blvd, St. Louis, MO 63104. Additionally, you would not report one of the observation codes, as the first of the following case studies explains.
No differences were observed for ZIP code median household income quartile.
No author has professional or financial relationships with any companies that are relevant to this study. Ask Suspected or Confirmed Iyengar R, Sabik L. The dangerous shortage of domestic violence services.
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Patient characteristics included age in years (>25, 2635, 3650, and >50), gender, ZIP code median household income quartile, and insurance status (Medicare, Medicaid, private, and self-pay, no charge, or other).
Sexual violence victimization of women: prevalence, characteristics, and the role of public health and prevention. Additionally, you would not report one of the observation codes, as the first of the following case studies explains. Factors that influence the variability in findings of anogenital injury in adolescent/adult sexual assault victims: a review of the forensic literature.
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Treating a child who has been physically or sexually abused has to be one of the most difficult tasks pediatricians face in their work. As a marker for more severe injury, we also included the number and types of procedures coded on the patients discharge record using the Common Procedural Technology (CPT) or Healthcare Common Procedure Coding System (HCPSC) collection of codes.
This means adding either A (Initial encounter), D (Subsequent encounter), or S (Sequela) to the code to indicate the progress of the patients treatment. Healthcare systems need to develop policies and practices that support ED providers in screening, treating, and providing appropriate referrals for sexual assault, with concerted efforts toward male victims and victims under the influence of alcohol. Also, you would use Z04.42 as a secondary to the findings, suggests Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana. Tadros A, Sharon MJ, Hoffman SM, et al.
In Pediatric Coding Alert volume [], And make sure your practice is prepared for the worst. %PDF-1.2
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H]o0LiWUlvAmc|,2c(T! Documentation that casts doubt on survivors may increase stigma, decrease engagement with follow up, and impede criminal justice proceedings. Research suggests that rural areas have more geographic and economic barriers to seeking healthcare.28,29 Furthermore, a lack of Sexual Assault Nurse Examiner (SANE)-trained nurses in rural areas has been empirically documented and may explain the difference in confirmed vs alleged sexual assault coding for sexual abuse between urban and rural hospitals.30.
Hirshon JM, Warner M, Irvin CB, et al. Sexual assault training in emergency medicine residencies: A survey of program directors.
Laitinen FA, Grundmann O, Ernst EJ. Lisak D, Gardinier L, Nicksa SC, et al.
Trying to move the elephant in the living room: responding to the challenge of false rape reports. DeMatteo D, Galloway M, Arnold S, et al. Of course, the issue of child abuse goes beyond simply coding for the patients situation.
government site. Your pediatrician initially suspects that the childs father has physically abused him. The National Intimate Partner and Sexual Violence Survey (NISVS): 2015 Data Brief-Updated Release National Center for Injury Prevention and Control. Federal Bureau of Investigation: Uniform Crime Reporting Statistics. The study relies on the NEDS database with the inherent limitations of use of administrative databases for research purposes.3739 NEDS relies on complete and accurate coding by participating institutions but coding may be incomplete. Its not just a job. Treating a child who has been physically or sexually abused has to be one of the most difficult tasks pediatricians face in their work.
The site is secure. Thats why we put together this guide to help you code the conditions accurately and help your entire practice work with victims if or when the situation arises. Administrative database studies: Goldmine or goose chase. Jina R, Thomas LS. Peterson C, DeGue S, Florence C, et al. From a coding perspective, the distinction is significant as it affects subsequent code choices, as the guidelines go on to explain. 0000002378 00000 n
