ED Coding and Reimbursement Alert

Question: A 6-year-old girl with a black eye reported to the ED. The physician's notes reflect that when the nurse questioned the child about how the injury happened, the mother spoke up before the girl could, saying that the girl had been hit in the face by a soccer ball. This didn't add up, though. If the physician group wants us to be on the lookout for cases of potential abuse and repeat/multiple visits, what are some of the codes we might look out for?

California Subscriber
 
Answer: It is possible that this child was a victim of physical abuse, especially when you consider that the mother answered the nurse's questions, not the child. Black eyes, especially when coupled with suspect explanations, might signal abuse.
 
Here are some of the more common injuries child abuse victims have. Be on the lookout for these injuries and other repetitive visits when screening for abuse:

- burns (e.g., 944.18, Burn of wrist[s] and hands; erythema [first degree]; multiple sites of wrist[s] and hand[s])

- bites (e.g., 881.00, Open wound of elbow, forearm, and wrist; without mention of complication; forearm)

- bruises (e.g., 920, Contusion of face, scalp, and neck except eye[s]) .

Reader Questions and You Be the Coder reviewed by Michael A. Granovsky, MD, CPC, FACEP, vice president of Medical Reimbursement Systems Inc., an ED coding and billing company in Woburn, Mass.