Adult abuse leading to missed dialysis
We have a patient whose abuser was preventing her from receiving dialysis and as a result present with severe electrolyte imbalances. She had no physical injuries requiring treatment but had a prolonged stay requiring extensive case management involvement to ensure a safe discharge disposition.
I believe based on OCG and coding clinic the PDX should be abuse.
"Sequence first the appropriate code from categories T74, Adult and child abuse, neglect and other maltreatment, confirmed, or T76, Adult and child abuse, neglect and other maltreatment, suspected, for abuse, neglect and other maltreatment, followed by any accompanying mental health or injury code(s)."
The coders are hung up the statement "injury codes". I do not believe that this is what is intended by this guideline.
Coding clinic seems to state that even in the absence of physical injury the abuse should be sequenced first followed by any associated diagnoses, not just physical injuries.
ICD-9-CM Coding Clinic, First Quarter 1998 Page: 11 Effective with discharges: January 15, 1998...A code from subcategory 995.5 may be used alone if no injuries or signs or symptoms are present on the child. However, it is extremely important that additional codes be used should there be any associated diagnoses or signs or symptoms to allow for detailed data collection on cases of abuse. This applies to adult abuse as well. A similar "use additional code" note is also under the adult abuse codes 995.80-995.85.
Thoughts? The case has been submitted to coding clinic. If anyone has any pull with the coding clinic advisory board, can we make addressing kind of scenario this one a priority?
Thanks
Colleen