assault coding guidelines
Agency for Healthcare Research and Quality. Delayed help-seeking may affect victims abilities to have crucial forensic evidence collected (ie, SANE exam). However, supplemental analysis of the exact CPT codes used did not suggest more severe injuries in cases coded as sexual assault as billing level/medical complexity and procedures were similar between groups. Medical evaluation after sexual assault frequently occurs in the emergency department, and documentation of the visit plays a significant role in decisions regarding prosecution and outcomes of legal cases against perpetrators. 8600 Rockville Pike Your pediatrician examines the patient and confirms the patients allegations. http://creativecommons.org/licenses/by/4.0/, https://www.cdc.gov/violenceprevention/pdf/sv_surveillance_definitionsl-2009-a.pdf, https://www.acep.org/globalassets/uploads/uploaded-files/acep/membership/sections-of-membership/forensic/sexual-assault-e-book2.pdf, www.hcup-us.ahrq.gov/db/nation/neds/NEDS_Introduction_2016.jsp, http://www.hcup-us.ahrq.gov/reports/methods/methods.jsp, https://ucr.fbi.gov/crime-in-the-u.s/2016/crime-in-the-u.s.-2016/topic-pages/tables/table-1, https://www.cdc.gov/violenceprevention/pdf/2015data-brief508.pdf. The urban-rural status of a hospital is based on the county of the hospital identified by the American Hospital Association (AHA). Laitinen FA, Grundmann O, Ernst EJ. Sexual assault training in emergency medicine residencies: A survey of program directors. This is our backyard: The experiences of expert legal and advocate providers with sexually assaulted women in rural areas. In this case, I would code S30.0XXA [Contusion of lower back and pelvis, initial encounter] and S70.12XA [Contusion of left thigh, initial encounter] and add a corresponding external cause code, such as Y93.61 [Activity, american tackle football], Wolf recommends. These biases may serve as barriers to male victims seeking care and perpetuate the myth that males are less likely to experience sexual assault. In this particular case, you would not report T76.12XA (Child physical abuse, suspected, initial encounter) as your pediatrician has ruled the physical abuse out after the examination. Less than half of sexual assault visits are coded as confirmed. Demographic factors and alcohol abuse account for a small percentage of the variation. The little tissue that couldnt dispelling myths about the hymens role in determining sexual history and assault. For example, providers may differ in their use of screening, brief intervention, and referral to treatment for at-risk alcohol use, which could affect the likelihood of being coded as alcohol use vs alcohol abuse. will also be available for a limited time. The current legal definition of rape stresses lack of consent and does not require the use of force,8 and the medical literature is clear that the presence of associated injuries is not required to prove the occurrence of sexual assault.912 The reported incidence of genital and other injuries associated with sexual assault is widely variable and depends on the methods used to detect injuries.13 However, victims are more likely to report the sexual assault and law enforcement is more likely to pursue investigation if there are associated physical injuries.1416 Guidelines developed by the American College of Emergency Physicians recommend coding encounters as sexual assault rather than using modifiers such as alleged or rule-out sexual assault.17 Given the importance of medical documentation on future legal proceedings, we sought to determine factors that are associated with coding sexual assault vs alleged sexual assault. Before you or anyone in your practice encounters a case of suspected or confirmed child physical or sexual abuse, the American Academy of Pediatrics (AAP) recommends that your practice has a protocol in place to respond that is consistent with legal reporting requirements,state-based statutes, and utilizes appropriate community resources. That includes knowing which authorities to contact and deciding on a safe place for the child when such an event occurs (Source: www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/resilience/Pages/Child-Abuse-and-Neglect.aspx). 
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Before you or anyone in your practice encounters a case of suspected or confirmed child physical or sexual abuse, the American Academy of Pediatrics (AAP) recommends that your practice has a protocol in place to respond that is consistent with legal reporting requirements,state-based statutes, and utilizes appropriate community resources. That includes knowing which authorities to contact and deciding on a safe place for the child when such an event occurs (Source: www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/resilience/Pages/Child-Abuse-and-Neglect.aspx). tells you to code confirmed cases of abuse or neglect with T74.- (Adult and child abuse, neglect and other maltreatment, confirmed), while suspected child abuse or neglect would be coded with a code from T76.- (Adult and child abuse, neglect and other maltreatment, suspected). Trying to move the elephant in the living room: responding to the challenge of false rape reports. Iyengar R, Sabik L. The dangerous shortage of domestic violence services. Sexual assault on college campuses: a 50-state survey of criminal sexual assault statutes and their relevance to campus sexual assault. Before Alternatively, it may be indicative of biases based on gender norms that stigmatize male victims. Unfortunately, it is an all-too-common occurrence in contemporary pediatrics. Of course, the issue of child abuse goes beyond simply coding for the patients situation. Rural EDs may ED identification of sexual assault has the potential to link victims to community services through referrals to counseling, victim advocates, and legal services services that have been empirically documented to improve psychological health and increase social support. Healthcare systems need to develop policies and practices that support ED providers in screening, treating, and providing appropriate referrals for sexual assault, with concerted efforts toward male victims and victims under the influence of alcohol. The hospital trauma level designation was obtained from the Trauma Information Exchange Program database. Similar to findings in Rudman et als work on coding of domestic violence, providers may be reluctant to code cases as confirmed sexual assault due to fears of stigmatizing the patient, unwillingness to commit to the diagnosis in face of uncertainty, or fear of medicolegal liability.35 Inadequate experience with sexual assault victims and the forensic exam during residency training may also contribute to uncertainty as to proper coding.36 This highlights the need for additional training regarding the importance of appropriate documentation and coding of sexual assaults. PMC legacy view The National Intimate Partner and Sexual Violence Survey (NISVS): 2015 Data Brief-Updated Release National Center for Injury Prevention and Control. Teaching status or trauma level of the hospital was not significantly associated with suspected vs confirmed sexual abuse. Additionally, you would not report one of the observation codes, as the first of the following case studies explains. As a marker for more severe injury, we also included the number and types of procedures coded on the patients discharge record using the Common Procedural Technology (CPT) or Healthcare Common Procedure Coding System (HCPSC) collection of codes. The number of CPT procedures appears to be slightly higher for individuals with confirmed sexual abuse. Additional correlates that may predict providers willingness to believe victims such as relationship of perpetrator to victim, provider gender, or confirmatory collateral history are not available from the database. Finding pure and simple truths with administrative data. We found that younger age, female gender, higher number of procedural services, urban hospital location, and lack of associated code for alcohol abuse were significantly associated with a code of confirmed sexual assault. Table 1 presents estimates of the association between suspected sexual abuse and confirmed sexual abuse regarding key sociodemographic and hospital-level factors. False allegations of sexual assault: An analysis of ten years of reported cases. Implications of this coding are discussed. and I.C.20.g. Documentation that casts doubt on survivors may increase stigma, decrease engagement with follow up, and impede criminal justice proceedings. This study employed data from the 2016 Nationwide Emergency Department Sample (NEDS) of the Healthcare Cost Utilization Project (HCUP) distributed by the US Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ).1820 The NEDS includes data on approximately 33 million hospital-based ED visits from 953 hospitals approximating a 20% sample of US hospital-owned EDs. This is where we live. Additionally, alcohol intoxication may increase uncertainty regarding the events surrounding the assault. In the same time period, there were 130,603 rapes reported to the Federal Bureau of Investigation.21 The most recent National Intimate Partner and Sexual Violence Survey estimated that 1,484,000 women are raped annually.22 In this context, we sought to determine factors that are associated with coding-confirmed sexual assault vs alleged sexual assault. and transmitted securely. and I.C.20.g. 
Treating a child who has been physically or sexually abused has to be one of the most difficult tasks pediatricians face in their work. official website and that any information you provide is encrypted In addition, should your pediatrician eventually rule out the suspicion of neglect, abuse, mistreatment, rape, or exploitation, ICD-10 guidelines instruct you not to report a T76.- code at all. From a coding perspective, the distinction is significant as it affects subsequent code choices, as the guidelines go on to explain. Federal Bureau of Investigation: Uniform Crime Reporting Statistics. Additionally, a perpetrator code (Y07) should be added when the perpetrators identity is known. trailer
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In this case, I would code S30.0XXA [Contusion of lower back and pelvis, initial encounter] and S70.12XA [Contusion of left thigh, initial encounter] and add a corresponding external cause code, such as Y93.61 [Activity, american tackle football], Wolf recommends. Pro Coding Tip: Typically, the evaluation and management (E/M) code for these types of visits will be billed based on time due to the extensive counseling that will have to take place, along with referrals and police reports that will have to be filed, Holle recommends. Additionally, I would code this with acode for any specific injury if documented in the chart and Y07.03 [Male partner, perpetrator of maltreatment and neglect] per ICD-10 guidelines to indicate it was the female patients boyfriend who was the perpetrator, Wolf adds. 0000001968 00000 n
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Houchens R, Elixhauser A Agency for Healthcare Research and Quality. The analytic sample consists of individuals who were discharged from US EDs in 2016 with a diagnostic code of either suspected (n = 5948, weighted n = 26,421; 95% CI, 21,84730,995) or confirmed sexual abuse (n = 5781, weighted n = 24,627; 95% CI, 21,25428,000). The influence of sexual assault resistance on reporting tendencies and law enforcement response: findings from the National Crime Victimization Survey. Sabina C, Ho LY. Nevertheless, alcohol intoxication does not negate reports of sexual assault. National Library of Medicine Ask Suspected or Confirmed Hospitals in large metropolitan areas with at least one million residents and those in small metropolitan areas were considered urban. Sexual assault and rape remain public health and medical crises in the United States. In 2016, there were approximately 26,421 adult discharges from EDs with a diagnostic code for suspected sexual abuse and 24,627 with confirmed sexual abuse. However, further examination and questioning of the patient reveals that the boy had been involved in a particularly rough game of tackle football with his friends. This study suggests that slightly less than half of ED visits for evaluation after sexual assault are coded as confirmed. Younger age, female gender, and urban location of hospital were associated with higher rates of coding as confirmed but ORs were low, and it is important to remember that false allegations of rape occur in 210% of cases, a rate similar to false reports for other crimes.31,32 Given the importance of the medical documentation, it is crucial that the ED record reflect the events as reported by the victim, corroborated by physical exam findings when present. Before coding for any suspected or confirmed physical or sexual child abuse, you should become familiar with two different sets of ICD-10 guidelines, which are found in I.C.19.f. In Pediatric Coding Alert volume [], And make sure your practice is prepared for the worst. Sexual assault is underreported. Cases coded as confirmed sexual assault had slightly more CPT procedures than cases coded as alleged. Thats because the observation Z codes are only for use when a person is being observed for a suspected condition that is ruled out, not for an injury, illness, or signs or symptoms related to the suspected condition. 0000000607 00000 n
In this case, I would code S30.0XXA [, In this case, Guideline 1.C.19.f comes into effect, and you would code T74.22XA(, Additionally, I would code this with acode for any specific injury if documented in the chart and Y07.03 [. Larsen ML, Hilden M, Lidegaard O.
The study relies on the NEDS database with the inherent limitations of use of administrative databases for research purposes.3739 NEDS relies on complete and accurate coding by participating institutions but coding may be incomplete. For cases of confirmed abuse or neglect coded with T74.-, guidelines I.C.19.f. Of course, the issue of child abuse goes beyond simply coding for the patients situation. Administrative database studies: Goldmine or goose chase. American College of Emergency Physicians. Your pediatrician initially suspects that the childs father has physically abused him. Hashimoto RE, Brodt ED, Skelly AC, et al. Bethesda, MD 20894, Web Policies Case Study 1: During an examination of a 10-year-old male patient, your pediatrician discovers extensive bruising around the childs buttocks and left thigh. Kjrulff MLBG, Bonde U, Astrup BS. Empirically documented correlates of sexual victimization include young age, female gender, childhood history of maltreatment, and substance use/abuse.1 Approximately 20% of women and 2% of men experience rape at some point in their lives, accounting for an estimated 1.2 trillion dollars in direct medical costs and a total of 3.1 trillion dollars when lost productivity and other indirect costs are included (2014 US dollars).2,3 Despite the deleterious and long-lasting physical and mental health conditions associated with rape and sexual assault, most of these assaults are never reported.46 According to Kimerling, the under-reporting of sexual assault may be attributed to the private, intimate nature of the assault and pervasive negative social consequences to disclosure.7 While it is widely accepted that sexual assault and rape are under-reported, medical personnel, law enforcement, the legal system, and society are often skeptical when victims do come forward. With respect to gender, those with confirmed sexual abuse were significantly more likely to be female than male (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.021.36); however, this difference is no longer significant when adjusting for sociodemographic and hospital factors. Guidelines for the care of sexual assault survivors recommend coding visits as sexual assault rather than modifiers that imply uncertainty. Information about the availability of SANE nurses is not included in the NEDS database and it was not possible to correlate coding to assessment by a SANE nurse.
In this case, Guideline 1.C.19.f comes into effect, and you would code T74.22XA(Child sexual abuse, confirmed, initial encounter). Email: Received 2020 Jul 12; Accepted 2020 Oct 12. What factors are associated with coding of sexual assaults by emergency physicians? Health issues of women in rural environments: an overview. Mishori R, Ferdowsian H, Naimer K, et al. tells you to code confirmed cases of abuse or neglect with T74.- (, And you will need to report the appropriate code from Z04.42 (, In this particular case, you would not report T76.12XA (, Thats because the observation Z codes are only for use when a person is being observed for a suspected condition that is ruled out, not for an injury, illness, or signs or symptoms related to the suspected condition. Guideline I.C.19.f. Annan SL. No differences were observed for ZIP code median household income quartile. This means adding either A (Initial encounter), D (Subsequent encounter), or S (Sequela) to the code to indicate the progress of the patients treatment. Tadros A, Sharon MJ, Hoffman SM, et al. American Hospital Association ("AHA"), www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/resilience/Pages/Child-Abuse-and-Neglect.aspx, Condition Spotlight: Answer These 4 Questions to Master Food Allergy Coding, Clip and Save: Use This Chart to Code Common Winter Conditions, You Be the Coder: Clarify Payer Guidelines to Avoid This Coding Headache. Full text available through open access at http://escholarship.org/uc/uciem_westjem. The analyses were weighted to account for the NEDS complex sampling design using the svyset command and svy prefix in Stata 14.2 (StataCorp, College Station, TX). Factors that influence the variability in findings of anogenital injury in adolescent/adult sexual assault victims: a review of the forensic literature. 
The hospitals urban-rural designation, trauma level, and teaching status were included in the analyses. An official website of the United States government. Case Study 2: A 16-year-old female patient reports to your pediatrician and confides that she has been forciblyraped by her boyfriend and that this is the first time she has told anyone about the incident. Its not just a job. Agency for Healthcare Research and Quality. The new PMC design is here! We conducted bivariate analyses to identify the prevalence of a diagnosis of confirmed sexual abuse or suspected sexual abuse among ED patients as well as provide descriptive statistics for these individuals. Lifetime economic burden of rape among U.S. adults. Moreover, alcohol intoxication may lead to delayed presentation to the ED after an assault, for fear of not being credible or facing negative consequences (ie, underage drinking). government site. Also, you would use Z04.42 as a secondary to the findings, suggests Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana. Sexual violence surveillance: uniform definitions and recommended data elements.
