ICD-10 codes used in pediatric exposure to intimate partner violence

OBJECTIVE: Identify common diagnostic codes for pediatric visits related to caregiver IPV in a healthcare system. 

DESIGN/METHODS: We conducted a secondary analysis of pediatric encounters for IPV-related care at a single urban healthcare system from July 2019 to June 2022. The study included visits to the pediatric emergency department (PED) or child advocacy center (CAC) following a child protective service referral. ICD-10-CM codes associated with each visit were descriptively summarized. We examined the relationship between the site of evaluation and the use of IPV-related diagnostic codes. 

RESULTS: Among 92 pediatric encounters (39 in the PED, 53 in the CAC), we identified 174 distinct ICD-10 codes. A majority of encounters, 78 (85%), were associated with IPV-related diagnostic codes, suspected abuse and/or a social concern (e.g., Z63, T74, T76, Z60). CAC encounters were more likely to have IPV-related diagnostic codes when compared to PED evaluations (98% vs 66%, p <0.01). 

DISCUSSION AND CONCLUSION(S): In the current study, ICD-10 code groups Z63, T74, T76, and Z60 were frequently used to document IPV exposure; however, their use varied significantly between the CAC and the PED. This variability may reflect both uncertainty among healthcare providers regarding documentation practices, along with concerns about the safety of children and caregivers following such disclosure. Additionally, the identified code groups lack specificity for IPV, limiting their effectiveness for systematically identifying such encounters. Given these limitations, ICD-10 codes alone may not constitute a robust mechanism for identifying IPV exposure in pediatric encounters.