ED Coding and Reimbursement Alert

Question: I am a new coder at a local ED. Recently, a child and her father showed up. The child had bruises on both arms and was bleeding from the nose. The father said she fell down the stairs, but the physician suspected child abuse because the injuries and the description of the accident did not mesh. I want to be able to identify potential child-abuse victims. What are some common symptoms/behaviors of an abused child?


Kentucky Subscriber
 

Answer: Each type of child abuse -- physical, emotional, sexual -- tends to manifest itself in different symptoms or behaviors.

But generally, if the child is a victim of physical abuse, she might:

- have unexplained injuries, such as burns, bites, bruises, broken bones or black eyes.
- have bruises or contusions that are still healing.
- have an irrational fear of one or both parents. 
- object when the ED encounter is over and the physician wants to send her home.
- cower when adults (even the physician and other ED professionals) approach her.

If the child is being emotionally abused, he might:

- behave in extremes. This could be an overly compliant or defiant child, or a child who displays extreme timidity or aggression.
- behave in an inappropriately adult or childlike manner.
- display signs of delayed physical or emotional development.
- display a lack of concern for his parent(s).

If the child is being sexually abused, she might:

- exhibit nonspecific symptoms like sleep disturbances, nightmares, phobias, abdominal pain, sudden change in appetite, difficulty walking or sitting, or refusing to participate in physical activities.
- exhibit developmentally unusual sexual behavior.
- be experiencing rectal or genital bleeding.
- have a sexually transmitted disease.
- be pregnant.