PHYSICIAN USE OF ICD-10 DIAGNOSIC CODES FOR CHILD AND ADULT ABUSE MALTREATMENT

The new ICD-10 Diagnostic Codes, that are scheduled to go into effect October 1, 2015 are a much broader categories allowing for more specific definitions, than the ICD-9 codes which previously, merely emphasized and included domestic offenses and victimizations.

The new, broader categories and more specific definitions include codes for both Child and Adult, Physical, Psychological Abuse, Sexual Abuse and Child, Neglect and Adult Unspecified Maltreatments and includes the definition for Coach temporary caregiver (caretaker). [DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services]

This reporter found that “Coach” was hidden in the category of “other” in the ‘Surgeon General’s Workshop on Making Prevention of Child Maltreatment a National Priority: Implementing Innovations of a Public Health Approach’ Lister Hill Auditorium, Rockville (MD), March 30 and 31 2005, Office of the Surgeon General (US), National Institutes of Health, Bethesda, Maryland.

When the publication was word-searched recently the following was the result:
“The following term not found in the book: Coach”
because “Coach” was buried several windows beneath the primary dissertation. In depth research was required for exposure.

Now the category “Coach” is clearly listed among “substitute caregivers” in ICD-10 codes and further defined as having a “temporary caregiving role with care and control of the child, and responsibility for the child’s health and welfare”, near exactly as this reporter stated, defined and referred to the GAO and other government officials.

This reporter concluded that his publications on this website, which began many years ago, requesting this category, “Coach, a temporary substitute caretaker” in his recommended amendment of definitions in Child Protections Laws, which was shared-to on request-by investigators from the U.S. Government Accountability Office after multiple emails and phone calls, had uncovered Coach from the category “other” and resulted in this monumental definition change, if not in whole, in part from his dedicated, persistent work.

This reporter frequently cited the “Coach” hidden omission in the U.S. Surgeon General’s 2005 Workshop in every conceivable communication with interested parties and reported the omission to the U.S. GAO and many U.S. Senators and Congress People. This reporter’s advocacy began in 2007 with intensive full time research and reporting.

For example: the report on this website June 9, 2013 after years of urgent request for both prevention sake of Athletes, who have suffered morbidity and mortality secondary to coaching endangerment and criminal and civil risk of Coaches, who have frequently been criminally and civilly charged and blindsided, stunned and shocked, because they lacked sufficient education and enlightenment from supposed overseers:

“CHILD ATHLETE ABUSE CONSEQUENCES HAVE NOT BEEN PROPERLY PUBLICIZED”
– from the June 9, 2013 report “COACH SUBSTITUTE CARETAKER” DEFINITION:
• The Coach is legally defined as a “Coach Substitute Caretaker” when Coaching Children less than 18 by KY and other states’ DCBS, CPS and U.S. CDC, U.S. NIH, U.S. Surgeon General, U.S. Department of Health and Human Services.
• Legal Scholars and Health Care officials have deciphered, know and understand the definitions for Coaches in the Law. They just haven’t shared them sufficiently with everyone else.
• Both States’ and Federal agencies and governments have made those “Coach-Substitute-Caretaker” declarations, but not publically
• The legal Role of the “Coach Substitute Caretaker” in Sports, Recreation and Exercise has not been properly authored in Section 3, Paragraph 2. of CAPTA 2010 and then issued, published and promulgated for Awareness to general public
• The legal Role of the “Coach Substitute Caretaker” is not “Crystal Clear” because it is not spelled out in the definition language of CAPTA 2010 Law Section 3. Paragraph 2.
– end June 9, 2013 report

Even during his 2009 Child Abuse training during breakout session, many of the Child Abuse “experts” in attendance denied that “Coaches” were “Temporary Substitute Caregivers”.

“Highlights of GAO-15-255, a report to the Committee on Finance, U.S. Senate about the INTERNATIONAL CLASSIFICATION OF DISEASES January 2015 CMS’s Efforts to Prepare for the New Version of the Disease and Procedure Codes

“Why GAO Did This Study”
“In the United States, every claim submitted by health care providers to payers—including Medicare and Medicaid—for reimbursement includes ICD codes. On October 1, 2015, all covered entities will be required to transition to the 10th revision of the codes, requiring entities to develop, test, and implement updated information technology systems. Entities must also train staff in using the new codes, and may need to modify internal business processes. Centers for Medicare & Medicaid Services(CMS) has a role in preparing covered entities for the transition. GAO was asked to review the transition to ICD-10 codes. GAO (1) evaluated the status of CMS’s activities to support covered entities in the transition from ICD-9 to ICD-10 coding; and (2) described stakeholders’ most significant concerns and recommendations regarding CMS’s activities to prepare covered entities for the ICD-10 transition, and how CMS has addressed those concerns and recommendations. GAO reviewed CMS documentation, interviewed CMS officials, and analyzed information from a nonprobability sample of 28 stakeholder organizations representing covered entities and their support vendors, which GAO selected because they participated in meetings CMS held in 2013 or met GAO’s other selection criteria. GAO provided a draft of this report to HHS. HHS concurred with GAO’s findings and provided technical comments, which GAO has incorporated, as appropriate.”

It is imperative that Prevent Child Abuse America, and each PCAstate, DCBS, CPS, Schools, National Federation of State High School Associations (nfhs), all state high school athletic associations and all Non-School federations, associations, and leagues and other organizations educate Coaches:
• that Coaches are Temporary Substitute Caretakers and subject to Child and Adult Abuse, Neglect and Maltreatment Law, because they have custody and control of the Child during Athletic participation, not the parent, guardian, heretofore not defined, not “crystal clear”
• the new broader diagnostic codes imposed on doctors and all health care workers,
• who, following athletic injuries, are mandatory reporters to authorities
• who are subject to charges for failure to report athletic abusive and maltreatment injuries
• because doctors and all health care workers, including trainers, are subject to criminal charges for failure to report and malpractice.
• Most of the above organizations have ignored my plea.
• Schools, organizations and their administrators don’t risk punishments for abuse and maltreatment injuries to Athletes.
• Only the Coaches, who have no immunity to Child Protection Laws, stand to be charged.
• therefore attempt to prevent Coaches from being blind sided with unlawful and civil difficulties is IMPERATIVE.

“Caregiver: A caregiver is a person, or people, who at the time of the maltreatment is in a permanent (primary caregiver) or temporary (substitute caregiver) custodial role. In a custodial role, the person is responsible for care and control of the child and for the child’s overall health and welfare.

• Primary caregivers must live with the child at least part of the time and can include, but are not limited to, a relative or biological, adoptive, step-, or foster parent(s); a legal guardian(s); or their intimate partner 7.
• Substitute caregivers may or may not reside with the child and can include clergy, coaches, teachers, relatives, babysitters, residential facility staff, or others who are not the child’s primary caregiver(s).

‘Harm: Any acute disruption caused by the threatened or actual acts of commission or omission to a child’s physical or emotional health (ISPCAN 2003). Disruptions can affect the child’s physical, cognitive, or emotional development. Threat of harm occurs when a parent or caregiver expresses an intention or gives signs or warnings through the use of words, gestures, or weapons to communicate the likelihood of inflicting harm to the child. Threat of harm can be explicit or implicit. Explicit threats would include such acts as pointing a gun at the child or raising a hand as if to strike the child.

‘Implicit threats would include such acts as kicking holes in walls or breaking down doors. Disruption of physical health includes, but is not exclusive to, physical injuries, avoidable illnesses, and inadequate nutrition.

“Discussion: We recommend collecting data on all the index child’s primary caregivers and any adults who were responsible for the child at the time of the maltreatment incident. Individuals responsible for the child at the time of the incident can include a single caregiver or multiple caregivers depending on the context, and can include the primary caregiver(s) or a substitute caregiver selected by the child’s primary caregiver. Primary caregivers must live with the child at least part of the time and may include, but are not limited to a relative or biological, adoptive, step-, or foster parent(s); legal guardian(s); or the caregiver’s intimate partner. Caregivers responsible for the index child at the time of the maltreatment may or may not live with the child. A substitute caregiver is defined as having a temporary caregiving role, care and control of the child, and responsibility for the child’s health and welfare. Substitute caregivers can include but are not limited to the following:

• Babysitter
• Residential facility staff
• Teacher
• Clergy
• Coach
• Relatives of the child who are not primary caregivers
• Romantic partner of the primary caregiver (also known as boyfriend/girlfriend, paramour, significant other, intimate partner)

*Expanded data element 98 For the purpose of the document, incident is defined as any contact with CPS, law enforcement, the medical system, or other reporting sources where child maltreatment is alleged or confirmed Information for some data elements in this section may not be available for non-primary caregivers; therefore, developers of the surveillance system will need to decide how missing data should be handled.

“Drawbacks of the current system, ICD-9-CM, include:
o It does not provide the necessary detail for patients’ medical conditions or the procedures and services performed on hospitalized patients;
o It is 36 years old; ™ It uses outdated and obsolete terminology; ™ It uses outdated codes that produce inaccurate and limited data; and ™ It is inconsistent with current medical practice as it cannot accurately describe the diagnoses and inpatient procedures of care delivered in the 21st century. ICD-10-CM/PCS consists of two parts:
o ICD-10-CM – The diagnosis classification system developed by the Centers for Disease Control and Prevention for use in all United States (U.S.) health care treatment settings. Diagnosis coding under this system uses 3–7 alpha and numeric digits and full code titles, but the format is very much the same as ICD-9-CM; and
o ICD-10-PCS – The procedure classification system developed by the Centers for Medicare & Medicaid Services (CMS) for use in the U.S. for inpatient hospital settings only.

“The compliance date for implementation of ICD-10-CM/PCS is October 1, 2015, for all Health Insurance Portability and Accountability Act (HIPAA)-covered entities. ICD-10-CM, including the “ICD-10-CM Official Guidelines for Coding and Reporting,” will replace ICD-9-CM diagnosis codes in all health care settings for diagnosis reporting with dates of service, or dates of discharge for inpatients, that occur on or after October 1, 2015. ICD-10-PCS, including the “ICD-10-PCS Official Guidelines for Coding and Reporting,” will replace ICD-9-CM procedure codes.

Insert – ICD-10 Codes continued below. – About Collegiate Athletes – Definition of Fiduciary Relationship

“A fiduciary relationship arises where one party places its trust and confidence in a dominant party.12 The Second District Court of Appeal in Prescott v. Kreher, 123 So. 2d 721 (Fla. 2d DCA 1960), for instance, held that a fiduciary relationship generally exists where a confidence is reposed and, on the other side, there is the resultant superiority and influence. . . . The relation need not be legal but may be moral, social, domestic, or purely personal. Thus, the term, “fiduciary” or “confidential” relation as defined is a very broad one. Such a relation has been said to exist and to suffice as a predicate for relief in all cases wherein confidence has been reposed and betrayed. 13

“Under this general rule, particular relationships, including husband and wife,14 principle and agent,15 trustee and beneficiary,16 attorney and client,17physician and patient,18 guardian and ward,19 and minister and parishioner,20 have been held by courts to be fiduciary relationships under Florida law. Fiduciary relations also can emerge, as a matter of fact, from other types of relationships.21 In instances when a fiduciary relationship exists, Florida law imposes on the more powerful party (the fiduciary) a duty to act for the benefit of the principal in all matters relevant to the relationship.22

Fiduciary Relationships in Collegiate Sports

“In the context of intercollegiate athletics, the nature of the university and student athlete relationship supports the protection of student athletes’ intercollegiate expectations and potential benefits from a professional sports career.23 Although no Florida court has ruled that a college or university owes a fiduciary duty to its student athletes,24 the lack of judicial recognition should not deter academic institutions from recognizing and protecting against the potential legal obligations arising from this type of relationship. Moreover, the extension of the fiduciary concept to the university and student athlete relationship could be imposed by Florida courts to maintain the law’s relevance with the evolving and complex world of intercollegiate athletics.25

“Application of fiduciary concepts in the intercollegiate sports context is supported by several scholars and commentators. One scholar noted that “the law of fiduciary obligation has developed through analogy to contexts in which the obligation conventionally applies.”26 Under this methodology, scholars and commentators have identified several factors inherent in the university and student athlete relationship that warrant the application of fiduciary concepts to this special relationship.27 One commentator, for example, opined that “[t]he most prominent of these factors is the dominance and control which a university exercises over the lives of student athletes.”28 Interestingly, the Colorado Supreme Court in University of Colorado v. Derdeyn, 863 P.2d 929 (Colo. 1993), noted the tremendous influence that a university exerts over its student athletes: “[Student athletes] submit to extensive regulation of their on- and off-campus behavior, including maintenance of required levels of academic performance, monitoring of course selection, training rules, mandatory practice sessions, diet restrictions, attendance at study halls, curfews, and prohibitions on alcohol and drug use.”29

“The Derdeyn court, relying on the testimony of a director of athletics, also looked at the level of dominance college coaches have over student athletes: “[S]ome coaches within their discretion impose curfews; that athletes are required to show up for practice; that athletes are ‘advised. . . on what they should take for classes’; that ‘we have a required study hall in the morning and in the evening’; and that it is ‘fair to say that the athletes are fairly well regulated.’”30

“Accordingly, college coaches develop a special influential relationship with student athletes based on trust and dependence because of the multiple roles coaches play in student athletes’ lives.31 Consequently, an academic institution, through its coaches, has a dominant role into and control over the lives of student athletes that creates a special, or fiduciary, relationship.32 The fiduciary nature of the relationship, therefore, gives the university the responsibility to carry out the reasonable expectations of student athletes.33

University’s Fiduciary Duties

“If Florida courts begin to apply fiduciary concepts in the intercollegiate athletics context, colleges and universities need to become more aware of their fiduciary duties if athletics staff members improperly refer student athletes to sports agents for compensation. Simply, the existence of a university and student athlete fiduciary relationship involves the imposition of the highest standard of duty implied by law.34

“The scope of this special duty can be defined through analogy from cases where courts have acknowledged the special duty universities owe to their students in other circumstances. The U. S. Court of Appeals for the Third Circuit in Kleinknecht v. Gettysburg College, 989 F.2d 1360 (3d Cir. 1993), held that a special relationship existed between a college and a student athlete that was sufficient to impose a duty of reasonable care on a college.35

“Florida has imposed a duty on universities to protect their students in limited situations. The Fourth District Court of Appeal in Gross v. Family Services Agency, Inc., 716 So. 2d 337 (Fla. 4th DCA 1998), held that a university had a duty to students to use ordinary care in providing educational services and programs.36 In particular, the Gross court concluded that “[w]hile a person or other entity generally has no duty to take precautions to protect another against criminal acts of third parties, exceptions to this general rule have emerged, including the ‘special relationships’ exception.”37

“Universities also are liable under other theories of negligence, including negligent hiring, retention, and supervision of employees (i.e., athletics staff).38Therefore, the existence of a special relationship between a university and its students imposes a corresponding duty of care.39

“Florida courts also have imposed a duty on public schools to supervise students placed within its care.40 In these cases, the courts have held that “a negligent failure to act in carrying out this duty of the school is actionable.”41 In carrying out the supervisory duty, a school, and its officials and teachers, “must use the degree of care ‘that a person of ordinary prudence, charged with the duties involved, would exercise under the same circumstances.’”42 A breach of this duty, furthermore, exposes a school to liability for “reasonably foreseeable injuries caused by the failure to use ordinary care.”43 The supervisory duty in Florida is based on the notion that the school is partially standing in place of the student’s parents.44

“Similarly, the university has two primary duties to student athletes under a fiduciary relationship. First, the university has an implied duty to limit institutional conduct that unreasonably interferes with the student athletes’ ability to develop and participate athletically.45 For example, arbitrary and capricious conduct that interferes with an opportunity for student athletes to participate in intercollegiate athletics would be precluded under this duty.46 Second, institutional conduct which promotes its interests ahead of that of the student athlete, is prohibited under this duty.47 The referral of student athletes to sports agents by athletics staff for compensation specifically would be prohibited under this duty because of the coach’s conflict of interest.

University Liability for Recommending Sports Agents

“Colleges and universities may be liable in a breach of fiduciary duty lawsuit if a sports agent, with whom an athletics staff member refers student athletes, damages a student athlete’s professional sports career aspirations and earnings. Florida appellate courts have yet to rule on the validity of student athletes’ property interests in intercollegiate eligibility or prospective professional sports earnings.48 Courts from other jurisdictions, however, are increasingly finding that student athletes have a protected property interest in their intercollegiate eligibility and prospective professional sports earnings.49The federal district court in Hall v. University of Minnesota, 530 F. Supp. 104 (D. Minn. 1982), for example, held that a student athlete’s opportunity to be drafted in the second round of the National Basketball Association draft was a private interest and, as such, protected by the United States Constitution.50In particular, the Hall court concluded that a student athlete “would suffer a substantial loss if his career objectives were impaired.”51 The Hall decision stands in contrast to decisions of courts in other jurisdictions, which held that student athletes do not have a protected property interest in either participating in intercollegiate athletics or future professional sports earnings.52 These holdings were based on the belief that future professional sports earnings, for instance, were “too speculative” to constitute a property interest.53 However, a student athlete’s future professional sports earnings can be ascertained more accurately today due to the sports industry’s use of sophisticated scouting techniques and projections and professional sports leagues’ imposition of rookie salary caps. 54

_________Continued ICD-10 Codes from above before the insert_______________

“The new procedure coding system uses 7 alpha or numeric digits while the ICD-9-CM coding system uses 3 or 4 numeric digits. The new classification system provides significant improvements through greater detailed information and the ability to expand to capture additional advancements in clinical medicine. ICD-10-CM/PCS improvements include:
o Much greater specificity and clinical information, which results in:
• Improved ability to measure health care services;
• Increased sensitivity when refining grouping and reimbursement methodologies;
• Enhanced ability to conduct public health surveillance; and Page 3
• Decreased need to include supporting documentation with claims;
o Updated medical terminology and classification of diseases;
o Codes that allow comparison of mortality and morbidity data; and
o Better data for:
• Measuring care furnished to patients;
• Designing payment systems;
• Processing claims;
• Making clinical decisions;
• Tracking public health;
• Identifying fraud and abuse;
• Conducting research
Adult and child abuse, neglect and other maltreatment, confirmed T74- >
Use Additional
• code, if applicable, to identify any associated current injury
• external cause code to identify perpetrator, if known (Y07.- )
Type 1 Excludes
• abuse and maltreatment in pregnancy (O9A.3- , O9A.4- , O9A.5- )
• adult and child maltreatment, suspected (T76.- )

T74 Adult and child abuse, neglect and other maltreatment, confirmed
T74.0 Neglect or abandonment, confirmed
T74.01 Adult neglect or abandonment, confirmed
T74.01XA …… initial encounter
T74.01XD …… subsequent encounter
T74.01XS …… sequela
T74.02 Child neglect or abandonment, confirmed
T74.02XA …… initial encounter
T74.02XD …… subsequent encounter
T74.02XS …… sequela
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
T74.2 Sexual abuse, confirmed
T74.21 Adult sexual abuse, confirmed
T74.21XA …… initial encounter
T74.21XD …… subsequent encounter
T74.21XS …… sequela
T74.22 Child sexual abuse, confirmed
T74.22XA …… initial encounter
T74.22XD …… subsequent encounter
T74.22XS …… sequela
T74.3 Psychological abuse, confirmed
T74.31 Adult psychological abuse, confirmed
T74.31XA …… initial encounter
T74.31XD …… subsequent encounter
T74.31XS …… sequela
T74.32 Child psychological abuse, confirmed
T74.32XA …… initial encounter
T74.32XD …… subsequent encounter
T74.32XS …… sequela
T74.4 Shaken infant syndrome
T74.4XXA …… initial encounter
T74.4XXD …… subsequent encounter
T74.4XXS …… sequela
T74.9 Unspecified maltreatment, confirmed
T74.91 Unspecified adult maltreatment, confirmed
T74.91XA …… initial encounter
T74.91XD …… subsequent encounter
T74.91XS …… sequela
T74.92 Unspecified child maltreatment, confirmed
T74.92XA …… initial encounter
T74.92XD …… subsequent encounter
T74.92XS …… sequela

2015 ICD-10-CM Diagnosis Code T74.12XA
Child physical abuse, confirmed, initial encounter
2015 Billable Code Pediatric Only Dx (0-17 years)
• T74.12XA is a billable ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
• On October 1, 2015 ICD-10-CM will replace ICD-9-CM in the United States, therefore, T74.12XA – and all other ICD-10-CM codes – should only be used for training or planning purposes until then.
• This is the American ICD-10-CM version of T74.12XA. Other international ICD-10 versions may differ.

Description Synonyms
• Child abuse, physical
• Child physical abuse
• Child victim of physical abuse
ICD-10-CM Coding Rules
• T74.12XA is only applicable to pediatric patients aged 0 – 17 years inclusive.

ICD-10-CM T74.12XA is grouped within Diagnostic Related Group(s) (MS-DRG v30.0):
• 922 Other injury, poisoning & toxic effect diag with mcc
• 923 Other injury, poisoning & toxic effect diag without mcc

Convert ICD-10-CM T74.12XA to ICD-9-CM
ICD-10-CM Code T74.12XA does not contain any entries in the ICD-10-CM Alpha Tabular Index. However, its parent code T74.12 contains the following entries:
• Maltreatment
child
physical abuse
confirmed T74.12

S00-T88
T74.12
ICD10Data.com Navigator T74.12XD

V00-Y99
2015 ICD-10-CM Diagnosis Code T74.11XA

Adult physical abuse, confirmed, initial encounter
2015 Billable Code Adult Only Dx (15-124 years)
• T74.11XA is a billable ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
• On October 1, 2015 ICD-10-CM will replace ICD-9-CM in the United States, therefore, T74.11XA – and all other ICD-10-CM codes – should only be used for training or planning purposes until then.
• This is the American ICD-10-CM version of T74.11XA. Other international ICD-10 versions may differ.

Description Synonyms
• Adult abuse, physical
• Adult abuse, physical, non-domestic
• Adult physical abuse
• Adult physical abuse, nondomestic
• Adult victim of non-domestic physical abuse
• Adult victim of physical abuse

ICD-10-CM Coding Rules
• T74.11XA is only applicable to adult patients aged 15 – 124 years inclusive.
ICD-10-CM T74.11XA is grouped within Diagnostic Related Group(s) (MS-DRG v30.0):
• 922 Other injury, poisoning & toxic effect diag with mcc
• 923 Other injury, poisoning & toxic effect diag without mcc

Convert ICD-10-CM T74.11XA to ICD-9-CM
ICD-10-CM Code T74.11XA does not contain any entries in the ICD-10-CM Alpha Tabular Index. However, its parent code T74.11 contains the following entries:
• Maltreatment
adult
physical abuse
confirmed T74.11

S00-T88
T74.11
ICD10Data.com Navigator T74.11XD
V00-Y99

2015 ICD-10-CM Diagnosis Code T74.92
Unspecified child maltreatment, confirmed
2015 Non-Billable Code
• T74.92 is not a billable ICD-10-CM diagnosis code and cannot be used to indicate a medical diagnosis as there are 3 codes below T74.92 that describe this diagnosis in greater detail.
• On October 1, 2015 ICD-10-CM will replace ICD-9-CM in the United States, therefore, T74.92 – and all other ICD-10-CM codes – should only be used for training or planning purposes until then.
• This is the American ICD-10-CM version of T74.92. Other international ICD-10 versions may differ.
The following ICD-10-CM Index entries contain back-references to ICD-10-CM T74.92:
• Maltreatment
child
confirmed T74.92

S00-T88
T74.91XS
ICD10Data.com Navigator T74.92XA
V00-Y99

2015 ICD-10-CM Diagnosis Code T74.91XA
Unspecified adult maltreatment, confirmed, initial encounter
2015 Billable Code Adult Only Dx (15-124 years)
• T74.91XA is a billable ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
• On October 1, 2015 ICD-10-CM will replace ICD-9-CM in the United States, therefore, T74.91XA – and all other ICD-10-CM codes – should only be used for training or planning purposes until then.
• This is the American ICD-10-CM version of T74.91XA. Other international ICD-10 versions may differ.
Description Synonyms
• Adult abuse
• Adult maltreatment syndrome
ICD-10-CM Coding Rules
• T74.91XA is only applicable to adult patients aged 15 – 124 years inclusive.
Convert ICD-10-CM T74.91XA to ICD-9-CM
ICD-10-CM Code T74.91XA does not contain any entries in the ICD-10-CM Alpha Tabular Index. However, its parent code T74.91 contains the following entries:
• Maltreatment
adult
confirmed T74.91

S00-T88
T74.91
ICD10Data.com Navigator T74.91XD
V00-Y99

Maltreatment
adult
abandonment
confirmed T74.01
suspected T76.01
confirmed T74.91
history of Z91.419
neglect
confirmed T74.01
suspected T76.01
physical abuse
confirmed T74.11
suspected T76.11
psychological abuse
confirmed T74.31
suspected T76.31
history of Z91.411
sexual abuse
confirmed T74.21
suspected T76.21
suspected T76.91
child
abandonment
confirmed T74.02
suspected T76.02
confirmed T74.92
history of – see History, personal (of), abuse
neglect
confirmed T74.02
history of – see History, personal (of), abuse
suspected T76.02
physical abuse
confirmed T74.12
history of – see History, personal (of), abuse
suspected T76.12
psychological abuse
confirmed T74.32
history of – see History, personal (of), abuse
suspected T76.32
sexual abuse
confirmed T74.22
history of – see History, personal (of), abuse
suspected T76.22
suspected T76.92

personal history of Z91.89

015 ICD-10-CM Diagnosis Code T74.22
Child sexual abuse, confirmed
2015 Non-Billable Code
• T74.22 is not a billable ICD-10-CM diagnosis code and cannot be used to indicate a medical diagnosis as there are 3 codes below T74.22 that describe this diagnosis in greater detail.
• On October 1, 2015 ICD-10-CM will replace ICD-9-CM in the United States, therefore, T74.22 – and all other ICD-10-CM codes – should only be used for training or planning purposes until then.
• This is the American ICD-10-CM version of T74.22. Other international ICD-10 versions may differ.
The following ICD-10-CM Index entries contain back-references to ICD-10-CM T74.22:
• Maltreatment
child
sexual abuse
confirmed T74.22
• Rape
child
confirmed T74.22

S00-T88
T74.21XS
ICD10Data.com Navigator T74.22XA
V00-Y99

2015 ICD-10-CM Diagnosis Code T74.21
Adult sexual abuse, confirmed
2015 Non-Billable Code
• T74.21 is not a billable ICD-10-CM diagnosis code and cannot be used to indicate a medical diagnosis as there are 3 codes below T74.21 that describe this diagnosis in greater detail.
• On October 1, 2015 ICD-10-CM will replace ICD-9-CM in the United States, therefore, T74.21 – and all other ICD-10-CM codes – should only be used for training or planning purposes until then.
• This is the American ICD-10-CM version of T74.21. Other international ICD-10 versions may differ.
The following ICD-10-CM Index entries contain back-references to ICD-10-CM T74.21:
• Maltreatment
adult
sexual abuse
confirmed T74.21
• Rape
adult
confirmed T74.21

S00-T88
T74.2
ICD10Data.com Navigator T74.21XA
V00-Y99

2015 ICD-10-CM Diagnosis Code T74.32
Child psychological abuse, confirmed
2015 Non-Billable Code
• T74.32 is not a billable ICD-10-CM diagnosis code and cannot be used to indicate a medical diagnosis as there are 3 codes below T74.32 that describe this diagnosis in greater detail.
• On October 1, 2015 ICD-10-CM will replace ICD-9-CM in the United States, therefore, T74.32 – and all other ICD-10-CM codes – should only be used for training or planning purposes until then.
• This is the American ICD-10-CM version of T74.32. Other international ICD-10 versions may differ.
The following ICD-10-CM Index entries contain back-references to ICD-10-CM T74.32:
• Maltreatment
child
psychological abuse
confirmed T74.32

S00-T88

T74.31XS
ICD10Data.com Navigator T74.32XA
V00-Y99

2015 ICD-10-CM Diagnosis Code T74.31
Adult psychological abuse, confirmed
2015 Non-Billable Code
• T74.31 is not a billable ICD-10-CM diagnosis code and cannot be used to indicate a medical diagnosis as there are 3 codes below T74.31 that describe this diagnosis in greater detail.
• On October 1, 2015 ICD-10-CM will replace ICD-9-CM in the United States, therefore, T74.31 – and all other ICD-10-CM codes – should only be used for training or planning purposes until then.
• This is the American ICD-10-CM version of T74.31. Other international ICD-10 versions may differ.
The following ICD-10-CM Index entries contain back-references to ICD-10-CM T74.31:
• Maltreatment
adult
psychological abuse
confirmed T74.31

S00-T88

T74.3
ICD10Data.com Navigator T74.31XA
V00-Y99

2015 ICD-10-CM Diagnosis Code T74.22
Child sexual abuse, confirmed
2015 Non-Billable Code
• T74.22 is not a billable ICD-10-CM diagnosis code and cannot be used to indicate a medical diagnosis as there are 3 codes below T74.22 that describe this diagnosis in greater detail.
• On October 1, 2015 ICD-10-CM will replace ICD-9-CM in the United States, therefore, T74.22 – and all other ICD-10-CM codes – should only be used for training or planning purposes until then.
• This is the American ICD-10-CM version of T74.22. Other international ICD-10 versions may differ.
The following ICD-10-CM Index entries contain back-references to ICD-10-CM T74.22:
• Maltreatment
child
sexual abuse
confirmed T74.22
• Rape
child
confirmed T74.22

S00-T88

T74.21XS
ICD10Data.com Navigator T74.22XA
V00-Y99

15 ICD-10-CM Diagnosis Code T74.21
Adult sexual abuse, confirmed
2015 Non-Billable Code
• T74.21 is not a billable ICD-10-CM diagnosis code and cannot be used to indicate a medical diagnosis as there are 3 codes below T74.21 that describe this diagnosis in greater detail.
• On October 1, 2015 ICD-10-CM will replace ICD-9-CM in the United States, therefore, T74.21 – and all other ICD-10-CM codes – should only be used for training or planning purposes until then.
• This is the American ICD-10-CM version of T74.21. Other international ICD-10 versions may differ.
The following ICD-10-CM Index entries contain back-references to ICD-10-CM T74.21:
• Maltreatment
adult
sexual abuse
confirmed T74.21
• Rape
adult
confirmed T74.21

S00-T88

T74.2
ICD10Data.com Navigator T74.21XA
V00-Y99

Unspecified child maltreatment, confirmed
2015 Non-Billable Code
• T74.92 is not a billable ICD-10-CM diagnosis code and cannot be used to indicate a medical diagnosis as there are 3 codes below T74.92 that describe this diagnosis in greater detail.
• On October 1, 2015 ICD-10-CM will replace ICD-9-CM in the United States, therefore, T74.92 – and all other ICD-10-CM codes – should only be used for training or planning purposes until then.
• This is the American ICD-10-CM version of T74.92. Other international ICD-10 versions may differ.
The following ICD-10-CM Index entries contain back-references to ICD-10-CM T74.92:
• Maltreatment
child
confirmed T74.92

S00-T88

T74.91XS
ICD10Data.com Navigator T74.92XA
V00-Y99

015 ICD-10-CM Diagnosis Code T74.91
Unspecified adult maltreatment, confirmed
2015 Non-Billable Code
• T74.91 is not a billable ICD-10-CM diagnosis code and cannot be used to indicate a medical diagnosis as there are 3 codes below T74.91 that describe this diagnosis in greater detail.
• On October 1, 2015 ICD-10-CM will replace ICD-9-CM in the United States, therefore, T74.91 – and all other ICD-10-CM codes – should only be used for training or planning purposes until then.
• This is the American ICD-10-CM version of T74.91. Other international ICD-10 versions may differ.
The following ICD-10-CM Index entries contain back-references to ICD-10-CM T74.91:
• Maltreatment
adult
confirmed T74.91

S00-T88

T74.9
ICD10Data.com Navigator T74.91XA
V00-Y99

[ICD-10-CM/PCS THE NEXT GENERATION OF CODING, June 15, 2015 DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services]

________________________

[Physician Use Of Diagnostic Codes For Child and Adult Abuse,\
J Am Med Womens Assoc. 2000 Summer; 55 (4):243.]
Diagnostic codes for abuse are not often used. Because these codes represent an important tool for reporting the prevalence and incidence of abuse, such documentation could lead to greater support for health care policies and resource allocation for victims of abuse. Lack of awareness about the diagnostic codes for abuse may be one explanation for underuse, but other barriers are also discussed.
In this study, only 93 diagnoses of child or adult abuse were coded for 351,359 patient visits during the four years. As we would expect, child abuse was diagnosed more often than adult abuse (67 v 26), and the majority of cases (n = 57) were visits to emergency departments.
[ADVANCE, ICD-10 TRANSITION TIPS AND TOOLS
How ICD-10 Differs From ICD-9-CM, Part 9, By Carol Spencer, RHIA, CCS, CHDA, Dec 6, 2010]
‘Adult and Child Abuse, Neglect, and Other Maltreatment provides guidance to sequence of first the appropriate code from categories T74.- or T76.- for abuse, neglect, and other maltreatment, followed by an accompanying mental health or injury code(s).’
“If the documentation in the medical record states abuse or neglect, it is coded as confirmed. It is coded as suspected if it is documented as suspected.”
“For cases of confirmed abuse or neglect, an external cause code from the assault section (X92-Y08) should be added to identify the cause of any physician injuries.
“Add a perpetrator code (Y07) when the abuser is known. If a suspected case of abuse, neglect or mistreatment is ruled out during an encounter, use code Z04.71, suspected adult physician and sexual abuse, ruled out, or code Z04.72, suspected child physical and sexual abuse, ruled out. Do not use code from T76.
“If the external cause is included in the complication-of-care codes, the code includes the nature of the complication as well as the type of procedure that caused it. For this reason, no external cause code indicating the type of procedure is necessary. If the complication-of-care codes within the body system chapter are specific to its organs and structures, sequence these codes first followed by a code(s) for the specific complications, if applicable.”

_________________________________________
ICD-10-CM (2010)/CHAPTER 19/T66-T78
T74 Adult and child abuse, neglect and other maltreatment, confirmed
Excludes1: abuse and maltreatment in pregnancy (O94.3-O94.5-)
adult and child maltreatment, suspected (T76.-)
Use additional code, if applicable, to identify any associated current injury
Use additional external cause code to identify perpetrator, if known (Y07.-)
The appropriate 7th character is to be added to each code from category T74
A initial encounter
D subsequent encounter
S sequela
T74.0 Neglect or abandonment, confirmed
T74.01 Adult neglect or abandonment, confirmed
T74.02 Child neglect or abandonment, confirmed
T74.1 Physical abuse, confirmed
Excludes2: sexual abuse (T74.2-)
T74.11 Adult physical abuse, confirmed
T74.12 Child physical abuse, confirmed
Excludes2: shaken infant syndrome (T74.4)
T74.2 Sexual abuse, confirmed
Rape, confirmed
Sexual assault, confirmed
T74.21 Adult sexual abuse, confirmed
T74.22 Child sexual abuse, confirmed
T74.3 Psychological abuse, confirmed
T74.31 Adult psychological abuse, confirmed
T74.32 Child psychological abuse, confirmed
T74.4 Shaken infant syndrome
T74.9 Unspecified maltreatment, confirmed
T74.91 Unspecified adult maltreatment, confirmed
T74.92 Unspecified child maltreatment, confirmed

____________________________________

V-CODES
ABUSE
DSM-IV-TR Diagnostic Codes:
V61.21 Physical Abuse of Child
V61.21 Sexual Abuse of Child
V61.21 Neglect of Child
V61.1 Physical Abuse of Adult
V61.1 Sexual Abuse of Adult

DSM-IV-TR Diagnostic Codes:
V61.9 Relational Problem Related to a Mental Disorder or
General Medical Condition
V61.20 Parent-Child Relational Problem
V61.10 Partner Relational Problem
V61.8 Sibling Relational Problem
V61.81 Relational Problem Not Otherwise Specified

The above diagnostic codes will be used when the focus of service and/or clinical attention is the
perpetration of child or adult abuse and/or neglect not due to a mental disorder. The above codes
should be used as the primary diagnosis, coded on Axis I, when the participant can be
effectively treated using brief, problem solving therapy. Safety of the abused party should be the
first focus of any intervention.
The following guidelines are to be considered and rendered within the context of the
participant’s cultural, ethnic, and spiritual values in order to maximize the accuracy of the
diagnosis, the effectiveness of the treatment/intervention, and the best possible outcomes for the
participant and the family.
Diagnostic Guidelines:
1. These guidelines should be applied if the focus of the intervention/treatment is the
perpetrator of the abuse. If the participant is the victim of the abuse then the diagnostic
determination should be made as defined in the DSM-IV-TR, and coded as 995.5 for a child
or 995.81 for an adult.
2. Establish diagnostic accuracy as defined in DSM-IV-TR. The distinguishing feature of this
V-code is that the “focus of clinical attention is severe mistreatment of one individual by
another through physical abuse, sexual abuse, or child neglect.” . It is imperative that a
primary mental health diagnosis be ruled out, especially personality and substance related
disorders. Typically, this V-code category is time limited in terms of treatment. If more
acute treatment is needed, there is probably a primary mental health diagnosis that is not
clearly evident.
Assessment should include probing for symptoms associated with problems in relationships,
substance abuse and personality disorders. A comprehensive history of the participant
should be obtained as part of the assessment and should include history of previous
relationships, prior interventions concerning relationships, history and treatment history of
substance use and abuse as well as current medical and work problems.
ValueOptions Provider Handbook V-CODES/ABUSE
Copyright 2006: www.valueoptions.com Page 2 of 4
3. It may be necessary under Federal and State Regulations to report suspected abuse or neglect
to the appropriate authorities.
4. In the diagnostic formulation, consider the following behaviors or symptoms:
a. Child abuse and neglect may include, but are not limited to:
• Consistent and/or frequent conflict between parent and child
• Parental incompetence
• Lack of parental control in the home
• Poor parent-child communication
• Inappropriate use of discipline / heavy discipline or over-punishment
• Unrealistic expectations of child’s behavior
• Reports of truancy on the part of the child
• Parent overprotective of child
• Parental isolation of child
• Reports/descriptions of physical/sexual abuse by the parent or other adult (hitting,
kicking, slapping, torture or sexual activity)
• Reports/descriptions of emotional and verbal abuse including: withdrawal of
affection and humiliation
• Failure to provide a nurturing and safe living environment
• Misappropriation of the minor’s trust-funds; earnings or other financial
assets/properties via coercion and or manipulation.
b. Adult abuse (neglect):
• Consistent and/or frequent conflicts between client and another adult
• Reported efforts to maintain control of the other adult
• Poor communication between parties
• Inappropriate use of discipline in an adult relationship
• Unable to establish appropriate boundaries
• Overprotective of other adult
• Isolation of the other adult
• Reports/descriptions of physical/sexual abuse (hitting, kicking, slapping, torture
or unwanted sexual activity including sexual coercion or rape)
• Reports/descriptions of emotional and verbal abuse including withdrawal of
affection and humiliation
• Caregiver neglect including failure to provide necessary skilled nursing
assistance, proper nutrition, access to support for activities of daily living
ValueOptions Provider Handbook V-CODES/ABUSE
Copyright 2006: www.valueoptions.com Page 3 of 4
• Censoring/Editing of the Elder’s incoming or outgoing US Mail; telephone calls
or other electronic media.
• Misappropriation of the elder’s financial assets and/or properties via coercion;
manipulation or fraudulent actions.
c. Other behaviors or symptoms to consider:
• Anxiety/paranoia related to the relationship
• Symptoms or behaviors exacerbated by the use of substances
• Identified stalking behaviors including unwanted visits to another’s work location
• Difficulty concentrating at work due to focus on the victim of the abuse
• Negative relationships with co-workers or supervisors
• Legal problems related to behaviors toward family members
d. All five Axes should be part of the diagnostic assessment and attention paid to issues
of safety of the victim and others around the victim as well as the availability of
appropriate support systems.
Treatment Guidelines:
1. Goal of treatment should include the elimination of the abusive behaviors and the
establishment of more appropriate ways of relating to others. Note: It is critical that treating
clinicians focus particularly on engaging victims of abuse and neglect and motivating them
to follow through with treatment recommendations as well as educating first time users
regarding expectations of counseling services.
2. The individual should be given support to identify those behaviors which are abusive in
nature:
• Parenting techniques – physical and verbally abusive punishments
• Ways of communicating – verbal violence and degrading interactions
• Anger response – appropriate to the situation and controlled
3. The treatment should include the development of awareness of internal triggers for abusive
behavior.
4. Identification of coping and management techniques to reduce/eliminate abusive responses:
• Time out – cool down techniques
• Alternative behaviors
• Visualization of alternative methods of addressing an abuse generating situation
ValueOptions Provider Handbook V-CODES/ABUSE
Copyright 2006: www.valueoptions.com Page 4 of 4
5. Treatment should include strategies for victims of abuse to draw comfort and support from
healthy and positive relationships at work and involvement in community activities.
6. Therapeutic Modalities can include:
A. Individual Therapy
• Focused substance abuse treatment, as appropriate
• Behavior modification and anger management
B. Group Therapy
• Focused therapy for abusers stressing anger management
• Parent Effectiveness Training
• Care for the caregiver
C. Family Interventions
• Referrals to community based services for families in crisis
• Referrals to child or adult protective services
• Where appropriate family therapy focused on restructuring family interactions
D. Community Based Programs
• Self-Help groups such as Alanon and Alateen, and self-help for substance abusers
• Churches/Synagogues/Mosques with programs for families in crisis
• Respite Care for caregivers
• Visiting Nurses Association
• Adult/Child Day Care services
References:
American Psychiatric Association, May, 1994, Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition, American Psychiatric Association, Washington, DC.
James M. Oher, Daniel J. Conti, Arthur E. Jongsma, Jr., 1998, The Employee Assistance
Treatment Planner, John Wiley & Sons, Inc. New York.

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