Coding Tip: Bullying – What is it and how is it coded?
Kim Carrier RHIT, CDIP, CCS, CCS-P
Director of Coding Quality Assurance
AHIMA Approved ICD-10-CM/PCS Trainer
Did you know that October is National Bullying Prevention Month? For FY 2019, ICD-10-CM has added terminology to Chapter 19 codes to include bullying and intimidation/intimidation through social media. When coding a record with documented bullying, this is coded as child or adult psychological abuse (initial/subsequent encounter or sequela) either as confirmed or suspected. The encounter and whether this is confirmed or suspected is needed in order to assign the appropriate diagnosis code.
T74.32XA-Child psychological abuse, confirmed, initial encounter
T74.32XD-Child psychological abuse, confirmed, subsequent encounter
T74.32XS-Child psychological abuse, confirmed, sequela
T76.32XA-Child psychological abuse, suspected, initial encounter
T76.32XD-Child psychological abuse, suspected, subsequent encounter
T76.32XS-Child psychological abuse, suspected, sequela
Z62.811-Personal history of psychological abuse in childhood (used when only a history is documented without current issue or sequela)
T74.31XA-Adult psychological abuse, confirmed, initial encounter
T74.31XD-Adult psychological abuse, confirmed, subsequent encounter
T74.31XS-Adult psychological abuse, confirmed, sequela
T76.31XA-Adult psychological abuse, suspected, initial encounter
T76.31XD-Adult psychological abuse, suspected, subsequent encounter
T76.31XS-Adult psychological abuse, suspected, sequela
Z91.411-Personel history of adult psychological abuse
What is Bullying?
Bullying is unwanted and aggressive behavior that gives someone a real or a perceived power imbalance. Most bullying occurs in the school building but it is not limited to this site. It also occurs in neighborhoods, on buses, public places and even on the Internet. Bullying can happen anywhere and to anyone as there is no single characteristic that puts someone at risk. The bully is not always stronger or bigger than those that they are bullying.
Types of Bullying:
- Verbal-this type of bullying includes teasing, threats, taunting, calling of names or inappropriate sexual comments. Saying or writing mean things about someone is considered verbal bullying.
- Social/Relational—this type of bullying is when someone hurts another’s reputation or relationships. Saying something embarrassing about someone, spreading rumors, purposely leaving someone out, telling others not to be friends with a specific person.
- Cyberbullying—this type of bullying is a little of both verbal and social. This takes place over digital devices. This means sending or sharing negative, harmful, false or mean content about another person causing embarrassment or humiliation. This can occur via texts, online apps/games, or online social media. Remember, when this happens, this can create a permanent, public record so be cautious when putting anything on social media. It can embarrass or humiliate the one that is being bullied but it will also follow the bully and can reflect poorly when trying to get hired for a job or accepted into a school.
- Physical—this type of bullying is hurting a person or their possessions. Spitting, hitting, pinching, kicking, pushing, tripping, stealing someone’s possessions or breaking them, and making mean or rude hand gestures.
Did You Know? The most common type of bullying is verbal/social bullying.
Interesting Stats on Bullying:
- 28% of U.S. students in grades 6-12 have been bullied
- 20% of U.S. students in grades 9-12 have been bullied
- 30% of the younger population admit to bullying others
- 70.6% of the younger population say they have witnessed bullying by others
- 70.4% of teachers/school staff have witnessed bullying by others
- 57% of the time bullying will stop within 10 seconds when a bystander or witness intervenes
- 9% of U.S. students in grades 6-12 have been cyberbullied
- 15% of U.S. students grades 9-12 have been cyberbullied
- 55.2% of U.S. LGBTQ students experience cyberbullying
- 43% of students notify an adult of the bullying incident
- 8 out of 10 adults (study size 320) report they have been victims of cyberbullying in the last six months (2012 study). 80% of the 320 adults reported they had felt humiliated, ignored, or were the subject of online gossip at least once a week
Who is at Risk for Bullying?
- Being overweight or underweight or different than the bully
- Wearing glasses
- Being poor and unable to dress like others
- Being new to a school or area
- People that appear weak
- People with depression, anxiety or have low self-esteem
- Not being popular or having few friends
- A person that does not generally get along with others
- A person with a disability
- A person of a different race,/ethnicity, gender, religion or sexual orientation to that of the bully
Warning Signs of Bullying:
- Injuries without explanation
- Lost/broken personal possessions
- Self-harm or talk of suicide
- Avoidance of social situations
- Drop in a student’s grades
- Feeling sick or feigning sickness
- Change in eating and sleeping habits
- Increased use of electronic devices or hides their screens
- Closing social media accounts only to open a new one
- Lack of school participation (miss, skip, or drop out)
Characteristics of Children Likely to be a Bully:
- Have a lot of friends (part of “clicks”)
- Seem overly concerned about their popularity with others
- Like to dominate or be in charge all the time
- Some may be depressed, anxious, angry or less involved in school
- Easily pressured by others and are friends with others that are bullies
- Aggressive behavior
- Easily frustrated
- Have very little parental involvement/too much time on their hands unsupervised
- Difficulty following rules
- Think violence is positive
How Can We Prevent Bullying?
- Talk about it
- Help everyone know what is considered a form of bullying
- Be a role-model and show how to treat people with kindness and respect
- Teach how to respect diversity
- Build a safe work/school/home environment
- Let ALL know the rules and policies that they are expected to follow and then ENFORCE them
- Work together and pay attention to surroundings and what is going on
- Step in when you see someone being bullied or report to another (usually will stop in 10 seconds after intervention)
We can all make a difference by talking with our children and taking an interest in what is going on around us to help reduce these percentages of bullying. We should also be mindful of reporting when documented so that these statistics can be even more accurate going forward.
ICD-10-CM Alphabetic Index and Tabular
The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.
We have finished with the step-by-step coding tidbits on coding of spinal fusions. If you were not able to catch Parts 1-13 of this series focused on spinal fusions, please visit hiacode.com/topics/series/spinal-fusion-coding/.
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Part 3: Spinal Fusion Coding — Determine the Level(s) or Region of Fusion and Number of Vertebrae Fused
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