Presenter Status
Fellow
Abstract Type
Clinical Research
Primary Mentor or Principal Investigator
Kimberly A. Randell
Presentation Type
Oral Presentation
Start Date
12-5-2026 12:45 PM
End Date
12-5-2026 1:00 PM
Abstract Text
Background: Intimate partner violence (IPV) among caregivers impacts 1 in 5 US children annually. Encounters with survivors of IPV need to be carefully documented, as the perpetrator can obtain access to these records either legally or in duplicitous ways. ICD-10 codes are used to document problems addressed during a healthcare encounter. ICD codes have been used to monitor and assess IPV-related care provided in adult settings; knowledge of their use in pediatrics is limited. In 2023, the Centers for Medicare and Medicaid Services (CMS) revised billing guidelines to incorporate social determinants of health (SDOH) in the determination of medical complexity. The impact of these changes on ICD-10 code use in pediatric visits in which IPV is identified is unknown.
Objectives: (1) Describe ICD-10 code use when IPV is disclosed during a pediatric healthcare visit, comparing codes from healthcare providers vs an external billing service. (2) Compare use of IPV and SDOH-related codes before/after 2023 CMS billing changes.
Methods: This single-center pediatric retrospective study (January 2022-December 2023) examined ICD-10 codes used by medical providers and an external billing service for visits in which IPV was disclosed. The billing service reviews visit notes and applies additional codes as needed to reflect care provided. We identified possible cases via a standardized social work note used for all IPV disclosures and positive IPV screens; manual chart review confirmed IPV identification during the visit. A computerized report provided patient demographics and ICD- 10 codes. We excluded all medical codes from analysis. We used descriptive statistics to summarize SDOH, abuse-related, and non-specific code use.
Results: We reviewed a total of 2301 charts, and 616 charts met our inclusion criteria (348 in 2022, 268 in 2023) from the emergency departments, urgent cares, outpatient clinics, and inpatient units. We identified the top ten ICD-10 codes applied by providers and external billers. Providers used codes that were often problem or diagnosis-specific; billers applied more contextual and non-specific Y or Z codes related to person, place, or activity. No IPV-specific codes were among the most used codes, but 21 cases had Z63.8/other specified problems related to the primary support group. We did not see increased use of specific abuse or SDOH-related codes in 2022 vs 2023.
Conclusions: We saw no increase in the use of IPV-specific codes in our study, making such codes less useful for monitoring of care provided after IPV identification in pediatric settings than they have been shown to be for adult settings. We noted a significant number of non-specific code uses that may increase risk should an abusive partner get access to records. We did not see an increase in SDOH or abuse-related coding between 2022 and 2023, despite CMS billing changes.
Intimate Partner Violence and Diagnostic Codes in Pediatric Health Records
Background: Intimate partner violence (IPV) among caregivers impacts 1 in 5 US children annually. Encounters with survivors of IPV need to be carefully documented, as the perpetrator can obtain access to these records either legally or in duplicitous ways. ICD-10 codes are used to document problems addressed during a healthcare encounter. ICD codes have been used to monitor and assess IPV-related care provided in adult settings; knowledge of their use in pediatrics is limited. In 2023, the Centers for Medicare and Medicaid Services (CMS) revised billing guidelines to incorporate social determinants of health (SDOH) in the determination of medical complexity. The impact of these changes on ICD-10 code use in pediatric visits in which IPV is identified is unknown.
Objectives: (1) Describe ICD-10 code use when IPV is disclosed during a pediatric healthcare visit, comparing codes from healthcare providers vs an external billing service. (2) Compare use of IPV and SDOH-related codes before/after 2023 CMS billing changes.
Methods: This single-center pediatric retrospective study (January 2022-December 2023) examined ICD-10 codes used by medical providers and an external billing service for visits in which IPV was disclosed. The billing service reviews visit notes and applies additional codes as needed to reflect care provided. We identified possible cases via a standardized social work note used for all IPV disclosures and positive IPV screens; manual chart review confirmed IPV identification during the visit. A computerized report provided patient demographics and ICD- 10 codes. We excluded all medical codes from analysis. We used descriptive statistics to summarize SDOH, abuse-related, and non-specific code use.
Results: We reviewed a total of 2301 charts, and 616 charts met our inclusion criteria (348 in 2022, 268 in 2023) from the emergency departments, urgent cares, outpatient clinics, and inpatient units. We identified the top ten ICD-10 codes applied by providers and external billers. Providers used codes that were often problem or diagnosis-specific; billers applied more contextual and non-specific Y or Z codes related to person, place, or activity. No IPV-specific codes were among the most used codes, but 21 cases had Z63.8/other specified problems related to the primary support group. We did not see increased use of specific abuse or SDOH-related codes in 2022 vs 2023.
Conclusions: We saw no increase in the use of IPV-specific codes in our study, making such codes less useful for monitoring of care provided after IPV identification in pediatric settings than they have been shown to be for adult settings. We noted a significant number of non-specific code uses that may increase risk should an abusive partner get access to records. We did not see an increase in SDOH or abuse-related coding between 2022 and 2023, despite CMS billing changes.
