Primary Care Coding Alert

Cyberbullying makes its first appearance in ICD-10.

With just 320 additions, 172 revised codes, and three deleted codes, the changes to the 2019 ICD-10 are not as extensive as they have been in previous years. Even so, primary care coders need to take note: the T74 (Adult and child abuse, neglect and other maltreatment, confirmed) and T76 (… suspected) code sets have been overhauled this time around, and that means the changes will have an impact on your coding.

Beginning Oct. 1, 2018, the additions and revisions to these codes — and the addition of their corresponding encounter codes — will affect coding in the pediatric, family medicine, and internal medicine settings.

So, read on, find out which of these new external cause codes could affect your reporting, and let our experts provide their insights into the changes.

Bullying and Cyberbullying Now External Causes

The changes to the T74 and T76 codes begin with the addition of several conditions — bullying and intimidation and intimidation through social media — under the T74.3 (Psychological abuse, confirmed) and T76.3 (Psychological abuse, suspected) categories.

Kent Moore, senior strategist for physician payment at the American Academy of Family Physicians, believes the addition of such conditions is a sign of the times we live in. “I suspect those additions are being driven by the increased focus on bullying — both traditional and cyber-bullying — that is occurring in schools and other areas of society,” Moore observes, adding that “the new language makes clear that these codes include those types of abuse, too.” These terms “can now be more clearly classified as such for patients who have experienced them,” Moore notes.

Jan Blanchard, CPC, CPMA, pediatric solutions consultant at Vermont-based PCC, agrees with Moore that the additions finally acknowledge a significant problem in modern society. “It is huge to finally have a code for bullying and social media intimidation,” Blanchard observes, adding that “the codes will now be able to put data to what’s known to be a problem.”

New Codes for Adult, Child Sexual and Forced Labor Exploitation

The revisions also include the addition of four new codes to the Forced sexual and Forced labor exploitation confirmed and suspected code sets:

• T74.51/T76.51 — Adult forced sexual exploitation, confirmed/… suspected
• T74.52/T76.52 — Child sexual exploitation, confirmed/… suspected
• T74.61/T76.61 — Adult forced labor exploitation, confirmed/… suspected
• T74.62/T76.62 — Child forced labor exploitation, confirmed/… suspected.

This means “primary care providers now have an explicit way to report when someone is the confirmed or suspected victim of sexual or forced labor exploitation or that they are victims of sex traffickers, for example” Moore tells coders. And, though it seems obvious, because of the seriousness of the problems they describe, Blanchard reminds coders to make sure they use the codes whenever they are appropriate.

ICD-10 Adds Related Examination and Observation Codes

Unsurprisingly, the new T74/T76 codes have resulted in new encounter codes that you will need to use should the encounter result in your provider performing a related procedure such as counseling or some other form of care. Blanchard singles out the following three that will also come into effect on Oct. 1:

• 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
• Z62.813 — Personal history of forced labor or sexual exploitation in childhood.

These corresponding Z codes “simply capture the reporting of reasons for encounter beyond the codes for consequences of the abuse, even when that is not the focus of the current encounter,” Moore explains. They also add “more granularity when reporting adult and child abuse, neglect, and other maltreatment, either as a consequence to the patient or reason for the encounter,” Moore believes.