Child maltreatment surveillance following the ICD-10-CM transition, 2016-2018

Abstract

BackgroundChild maltreatment is poorly documented in clinical data. The International Classification of Diseases and Related Health Problems, 10th Revision, Clinical Modification (ICD-10-CM) represents the first time that confirmed and suspected child maltreatment can be distinguished in medical coding. The utility of this distinction in practice remains unknown. This study aims to evaluate the application of these codes by patient demographic characteristics and injury type.MethodsWe conducted secondary data analysis of emergency department (ED) discharge records of children under 18 years with an ICD-10-CM code for confirmed (T74) or suspected (T76) child maltreatment. Child age, sex, race/ethnicity, insurance status and co-occurring injuries (S00-T88) were compared by maltreatment type (confirmed or suspected).ResultsFrom 2016 to 2018, child maltreatment was documented in 1650 unique ED visits, or 21.7 per 10 000 child ED visits. Suspected maltreatment was documented most frequently (58%). Half of all maltreatment-related visits involved sexual abuse, most often in females and individuals of non-Hispanic white race. Physical abuse was coded in 36% of visits; injuries to the head were predominant. Non-Hispanic black children were more frequently documented with confirmed physical abuse than suspected (38.7% vs 23.7%, p<0.01). The rate of co-occurring injuries documented with confirmed and suspected maltreatment differed by 30% (9.2 vs 12.5 per 10 000 ED visits, respectively).ConclusionsThe ability to discriminate confirmed and suspected maltreatment may help mitigate clinical barriers to maltreatment surveillance associated with delayed diagnosis and subsequent intervention. Racial disparities in suspected and confirmed cases were identified which may indicate biased diagnostic behaviours in the ED.

Child maltreatment-related children's emergency department visits before and during the COVID-19 pandemic in Connecticut

“…Relevant cases were identified by a pre-determined set of inclusion/exclusion criteria, developed from previous literature ( Hunter et al, 2020 ; Lindberg, Beaty, Juarez-Colunga, Wood, & Runyan, 2015 ; Schnitzer, Slusher, Kruse, & Tarleton, 2011 ) and based on: (1) chief concerns, (2) keywords in ED provider notes, and (3) ICD-10-CM codes ( Table 1 ). Cases meeting at least one of these three criteria were included in the study sample for chart review.…”

Defining suspected child maltreatment using International Classification of Diseases codes: A scoping literature review

“…Additionally, we did not include articles that only used ICD-10 codes for suspected maltreatment (e.g., T76.1 for physical abuse, suspected). However, it is worth noting that these codes are also under-used (Durand, 2019;Hunter et al, 2021) and thus inadequately captured the breadth of suspected maltreatment. Instead, we focused on codes where the accidental or non-accidental nature of the event leading to the condition was ambiguous.…”

“…The ICD-10 nosology provides availability to document suspected maltreatment by distinguishing confirmed (e.g., ICD-10-CM code T74) and suspected (e.g., ICD-10-CM code T76) diagnosis of maltreatment (Feng et al, 2011), yet studies have indicated that the codes are still under-used (Hunter et al, 2021) and thus inadequately captured the breadth of suspected maltreatment. One study using retrospective chart review from a pediatric trauma center found that only 17% of suspected physical abuse cases identified by chart review were captured using ICD-10 diagnostic codes for suspected abuse (Durand et al, 2019).…”

Diagnostic Coding of Elder Mistreatment: Results From a National Database of Medicare Advantage and Private Insurance Patients, 2011–2017

“…Many of the cases coded as “suspected” elder mistreatment may not have been previously documented by ICD-9 codes due to the absence of a “suspected” category. Hunter and colleagues (2020) found in examining use of ICD-10 codes for child abuse between 2016 and 2018, 58% were suspected rather than confirmed maltreatment, suggesting widespread use of this newly available option. Although the addition of “suspected” codes may have modestly increased overall coding of elder mistreatment, it may also create issues with surveillance and research in differentiating between suspected and confirmed cases.…”