ICD-10 Codes Used in Pediatric Exposure to Intimate Partner Violence

Area of Science:

• Pediatric healthcare
• Public health
• Medical coding

Background:

• Intimate partner violence (IPV) significantly impacts child well-being.
• Accurate identification of IPV exposure in pediatric settings is crucial for intervention.
• Current diagnostic coding practices may not effectively capture all IPV-related pediatric encounters.

Purpose of the Study:

• To identify common International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes used for pediatric visits related to caregiver IPV.
• To compare the use of IPV-related diagnostic codes between pediatric emergency department (PED) and child advocacy center (CAC) evaluations.
• To assess the specificity and effectiveness of ICD-10 codes for identifying IPV in pediatric healthcare settings.

Main Methods:

• Secondary analysis of pediatric encounters for IPV-related care from July 2019 to June 2022.
• Inclusion of visits to the PED or CAC following a child protective service referral.
• Descriptive summarization of ICD-10-CM codes and examination of code usage based on evaluation site.

Main Results:

• 174 distinct ICD-10 codes were identified across 92 pediatric encounters.
• 85% of encounters were associated with IPV-related diagnostic codes, suspected abuse, or social concerns (e.g., Z63, T74, T76, Z60).
• Child advocacy center (CAC) encounters were significantly more likely to have IPV-related codes than pediatric emergency department (PED) evaluations (98% vs. 66%, p <0.01).

Conclusions:

• ICD-10 code groups Z63, T74, T76, and Z60 are frequently used but lack specificity for IPV.
• Variability in code usage between CAC and PED settings may indicate provider uncertainty or safety concerns.
• ICD-10 codes alone are insufficient for robustly identifying pediatric IPV exposure due to limited specificity and documentation inconsistencies.