Clinical documentation will need to reflect these situations in order to be accurately coded.
When beginning research for this article, I opened my 2018 ICD-10-CM book to the External Cause Index section, specifically for the word “harassment,” but it was missing.
The next area I reviewed was the Index, but again, the word was missing.
My next step was to open the PDF file of the 2018 ICD-10-CM tabular and search for the word “harassment,” and I found one instance: the code was Z56.81, which has a description of sexual harassment on the job. This code is found under the sub-category of Other Problems to Employment.
I have also reviewed the 2018 ICD-10-CM Official Coding and Reporting Guidelines and found not any mention of “harassment.” I also found that Z56.81 is not a Hierarchical Condition Category (HCC), either. I believe that this code would be a social determinant (social determent of health).
My basic search has led me to conclude that to capture any information related to sexual harassment, the coder would use the adult and child abuse portion of coding guidelines, which would be found in the Chapter Specific 19.f for the injury portion and Chapter Specific 20.g for the external cause code. The Chapter 19 information indicates that abuse is considered an assault. The important clinical documentation is if the assault is confirmed or suspected.
Confirmed sexual assaults are assigned a code from the T74.2 subcategory. The code further describes child (T74.22) or adult (T74.21) abuse. The T74.2- code will be the first listed, or principal diagnosis. Suspected or alleged sexual assaults would be assigned from subcategory T76.2. This code also further describes child (T76.22) or adult (T76.21) sexual assault. Additional diagnosis codes are added for the specific injuries that have been inflicted.
If the suspected sexual abuse is ruled out after investigation, then diagnosis code Z04.41 (Encounter for examination and observation following alleged adult rape) or Z04.42 (Encounter for examination and observation following alleged child rape) would be assigned. The T76.2 subcategory cannot be assigned with the Z04.4 subcategory.
Turning to the external cause portion of the coding leads the coder to the assault (X92-Y09) codes. These codes describe various types of injury, including by drowning, guns, explosives, sharp objects, blunt objects, and motor vehicles. One category that might be most appropriate in this context is Y04, which is assault by bodily force. When the abuse is confirmed, the perpetrator should be included, if known. In other words, if a T74.2- code is assigned, then a code from Y07 should be assigned if the perpetrator is known. The perpetrators identified in category Y07 can be spouse, parent, other family members, daycare provider, healthcare provider, teacher, or other non-family member.
My investigation led me to believe that specifics are lacking in the current version of ICD-10-CM for sexual harassment. The ICD-10-CM codes for the 2019 fiscal year were released on June 11, 2018, so my curiosity led me to check the latest version. It should be noted that the 2019 updates include diagnosis codes for bullying and sexual exploitation for categories T74 (confirmed abuse) and T76 (suspected abuse). The expanded codes include child and adult victims. The next concern is that the clinical documentation will need to reflect these situations so that they can be accurately coded.
Program Note
Listen tomorrow to Talk Ten Tuesday for more reporting on this issue by Laurie Johnson.
This a heads-up on a definitional change coming our way. There will be the launching of a new framework for obesity in mid-January, per a
In ICD-10-CM, we have the ability to assign very specific external cause codes. As noted in Chapter 20, they allow us to classify environmental events
Please log in to your account to comment on this article.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.
Copyright © 2024 ICD10monitor. Powered by MedLearn Media.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
