Pediatric Coding Alert

ICD-10 addresses neglect and exploitation as well.

The annual revisions to ICD-10 are upon us, and there are plenty of additions, deletions, and changes for peds coders to take note of. Among them are some significant revisions to the Other and Unspecified Effects of External Cause codes (T66-T78) that will come into effect on Oct. 1 of this year. 

To help you better understand the need for the revisions, and how and when to report these new codes, we’ve provided some context for them along with some expert analysis to show why they have been placed in the 2019 ICD-10 addenda.

Background and Reaction

The changes involve revisions to the T74 (Adult and child abuse, neglect and other maltreatment, confirmed) and T76 (Adult and child abuse, neglect and other maltreatment, suspected) code sets, and they begin with adding bullying and intimidation, along with intimidation through social media, as conditions that can now be reported under the T74.3 (Psychological abuse, confirmed) and T76.3 (Psychological abuse, suspected) categories. 

The change is long overdue, especially as a 2011 National Center for Education Statistics and Bureau of Justice Statistics study estimates that over a quarter of all students in grades 6-12 have been bullied, and 9 percent of students in that age group have been cyberbullied (Source: www.stopbullying.gov/media/facts/index.html).

The response to the change in the peds coding community is overwhelmingly positive. “This is an issue that all pediatricians and providers will want to address any time children present for well-care visits as well as sick visits for such problems as abdominal pain, headaches, a sudden decline in grades, poor attitude, or depression,” says Donelle Holle, RN, President of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana. “Adding bullying and intimidation with the T74.3 code will help to refer patients out or follow them very closely in the office to prevent any further issues,” Holle believes.

“Finally having a code for bullying and social media intimidation is huge,” agrees Jan Blanchard, CPC, CPMA, pediatric solutions consultant at Vermont-based PCC. And it’s not just because coders will have more specificity for their reporting after Oct. 1. “The new codes will now be able to put more data to what’s known to be a problem,” Blanchard notes.

Child Sexual and Forced Labor Exploitation Receive Codes

Gathering data will be important for another major social problem — child sex and labor trafficking — where accurate statistics are not currently available.

However, even without current data, there is ample evidence to justify the addition of four new codes in the 2019 ICD-10 to address these particular issues, as a recent policy statement from the American Academy of Pediatrics (AAP) indicates: “The global prevalence of human trafficking,” authors Jordan Greenbaum and Nia Bodrick write, “combined with its wide-ranging adverse health consequences, requires that these forms of severe exploitation be treated as an important public health problem” (Source: pediatrics.aappublications.org/content/140/6/e20173138).

The four codes in question involve exploitation that a provider must specify is either confirmed or suspected:

• T74.52 — Child sexual exploitation, confirmed
• T76.52 — Child sexual exploitation, suspected 
• T74.62 — Child forced labor exploitation, confirmed
• T76.62 — Child forced labor exploitation, suspected.

These are critical codes, and Blanchard points out that coders should immediately learn to use them whenever they are appropriate. And, Blanchard observes, the addition of these codes has also resulted in another change: the addition of two new encounter codes that you will use should the encounter result in your provider performing a related procedure such as counseling or some other form of care:

• Z04.81 — Encounter for examination and observation of victim following forced sexual exploitation 
• Z04.82 — Encounter for examination and observation of victim following forced labor exploitation.

And while you will still report Z62.81 (Personal history of abuse in childhood) for any personal history of sexual or psychological abuse in childhood, you will now be able to report a new code, Z62.813 (Personal history of forced labor or sexual exploitation in childhood), when your patient’s history involves sexual or labor trafficking.