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Validating Use of ICD-10 Diagnosis Codes in Identifying Physical Abuse Among Young Children
Irit R Rasooly1, Amina N Khan2, Maria C Aldana Sierra3
1Division of General Pediatrics, Children's Hospital of Philadelphia (IR Rasooly, MC Aldana Sierra, M Shankar, K Dang, JN Wood), Philadelphia, Pa; Center for Pediatric Clinical Effectiveness & PolicyLab, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research (IR Rasooly, JN Wood), Philadelphia, Pa; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania (IR Rasooly, K Dang, JN Wood), Philadelphia, Pa; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia (IR Rasooly, A Khan, L Cao), Philadelphia, Pa.
Insights
International Classification of Disease, 10th Revision, Clinical Modification (ICD-10-CM) codes can identify child physical abuse. However, the positive predictive value varies significantly among different ICD-10-CM codes used for diagnosis.
Area of Science:
- Pediatrics
- Public Health
- Medical Informatics
Background:
- Child physical abuse is a significant public health concern requiring accurate identification.
- International Classification of Disease, 10th Revision, Clinical Modification (ICD-10-CM) codes are utilized in healthcare settings to classify diagnoses, including suspected child maltreatment.
- Accurate coding is crucial for epidemiological studies, resource allocation, and clinical decision-making.
Purpose of the Study:
- To evaluate the positive predictive value (PPV) of specific ICD-10-CM codes in identifying young children (under 24 months) diagnosed with physical abuse.
- To assess the diagnostic certainty of physical abuse when these codes are applied in clinical encounters.
Main Methods:
- A retrospective review of 230 charts of children under 24 months with ICD-10-CM codes suggestive of physical abuse was conducted.
- Electronic health records were analyzed to determine if physical abuse was considered and to assess the level of diagnostic certainty.
- The positive predictive value of individual ICD-10-CM codes was calculated based on confirmed or likely abuse diagnoses.
Main Results:
- Of 230 charts, 91% had documentation of physical abuse being considered. Of these, 60% were rated as definitely or likely abuse.
- The PPV for specific ICD-10-CM codes varied widely, with T74.12 ('Adult and child abuse, neglect, and other maltreatment, confirmed') showing a high PPV of 0.89.
- Conversely, code Z04.72 ('Encounter for examination and observation following alleged child physical abuse') had a lower PPV of 0.24.
Conclusions:
- ICD-10-CM codes are valuable tools for identifying young children experiencing physical abuse.
- Healthcare providers and researchers should be aware that the PPV differs substantially across various ICD-10-CM codes for physical abuse.
- Utilizing codes with higher PPVs can improve the accuracy of identifying confirmed cases of child physical abuse.
Objective:
Evaluate the positive predictive value of International Classification of Disease, 10th Revision, Clinical Modification (ICD-10-CM) codes in identifying young children diagnosed with physical abuse.
Methods:
We extracted 230 charts of children <24 months of age who had any emergency department, inpatient, or ambulatory care encounters between Oct 1, 2015 and Sept 30, 2020 coded using ICD-10-CM codes suggestive of physical abuse. Electronic health records were reviewed to determine if physical abuse was considered during the medical encounter and assess the level of diagnostic certainty for physical abuse. Positive predictive value of each ICD-10-CM code was assessed.
Results:
Of 230 charts with ICD-10 codes concerning for physical abuse, 209 (91%) had documentation that a diagnosis of physical abuse was considered during an encounter. The majority of cases, 138 (60%), were rated as definitely or likely abuse, 36 cases (16%) were indeterminate, and 35 (15%) were likely or definitely accidental injury. Other forms of suspected maltreatment were discussed in 16 (7%) charts and 5 (2%) had no documented concerns for child maltreatment. The positive predictive values of the specific ICD-10 codes for encounters rated as definitely or likely abuse varied considerably, ranging from 0.89 (0.80-0.99) for T74.12 "Adult and child abuse, neglect, and other maltreatment, confirmed" to 0.24 (95% CI: 0.06-0.42) for Z04.72 "Encounter for examination and observation following alleged child physical abuse."
Conclusions:
ICD-10-CM codes identify young children who experience physical abuse, but certain codes have a higher positive predictive value than others.
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