2025 ICD-10-CM code T76.11
(Active) Effective Date: N/A Revision Date: N/A Injury - Adult and child abuse, neglect and other maltreatment, suspected Injury, poisoning and certain other consequences of external causes (S00-T88) Feed
Suspected adult physical abuse.
Modifiers may be applicable depending on the circumstances of the encounter and any additional services provided.Consult the appropriate coding guidelines for specific modifier usage.
The medical necessity is established by the physician's clinical judgment based on the patient's presentation, the plausibility of the explanations, and the presence of physical signs consistent with abuse.The physician's notes should justify the suspicion and the need for further evaluation and treatment.
The clinical responsibility rests on the physician to thoroughly examine the patient, document findings, and make a professional judgment about the possibility of abuse based on the patient's history, physical examination, and available evidence.This may involve reporting suspected abuse to the appropriate authorities.
- Injury, poisoning and certain other consequences of external causes (S00-T88)
- T76 - Adult and child abuse, neglect and other maltreatment, suspected
In simple words: This code is used when a doctor suspects that an adult has been physically abused, but they are not certain. More tests may be needed to confirm the abuse.
This code is used to classify cases of suspected physical abuse in adults where there is evidence suggesting abuse but it hasn't been definitively confirmed.It's crucial to note that this code signifies suspicion, not confirmation, and further investigation may be necessary.
Example 1: A 65-year-old woman presents with multiple bruises in various stages of healing, inconsistent with her explanation of accidental falls. The physician suspects physical abuse and codes T76.11., A 40-year-old man is brought to the emergency room after a fight with his partner. He has injuries consistent with physical assault, but refuses to disclose details about the event. The physician documents the injuries and codes T76.11 pending further investigation., A social worker refers a 72-year-old man with significant weight loss, poor hygiene, and unexplained injuries to a physician.Based on the assessment, the physician suspects neglect and physical abuse and codes T76.11 for the suspected abuse.
Detailed documentation is required, including a comprehensive history and physical examination noting all injuries, their location, severity, and the patient's explanation for them.Photographs of injuries are helpful.Documentation should include any statements made by the patient and any inconsistencies.If the patient is incapacitated, statements from family members or caregivers may be included.
** This code is for suspected abuse; it does not imply confirmation.Appropriate reporting procedures for suspected abuse should be followed. This code should be used in conjunction with codes that specify the injury and external cause if appropriate.
- Payment Status: Active
- Modifier TC rule: Not applicable.
- Specialties:Emergency Medicine, Family Medicine, Internal Medicine, Social Work
- Place of Service:Office, Emergency Room - Hospital, Inpatient Hospital, Other Place of Service