This category can be used when the focus of clinical attention is a normal reaction to the death of a loved one. As part of their reaction to such a loss, some grieving individuals present with symptoms characteristic of a major depressive episodchfor example, feel-
Other Conditions That May Be a Focus of Clinical Attention 717 ings of sadness and associated symptoms such as insonmia, poor appetite, and weight loss. The bereaxed individual typically regards the depressed mood as ”normal,” al- though the individual may seek professional help for relief of associated symptoms such as insomnia or anorexia. The duration and expression of "normal” bereavement vary con- siderably among different cultural groups. Further guidance in distinguishing grief from a major depressive episode is provided in the criteria for major depressive episode.
Maltreatment by a family member (e.g., caregiver, intimate adult partner) or by a nonrel- ative can be the area of current clinical focus, or such maltreatment can be an important factor in the assessment and treatment of patients with mental or other medical disorders.
Because of the legal implications of abuse and neglect, care should be used in assessing these conditions and assigning these codes. Having a past history of abuse or neglect can inﬂuence diagnosis and treatment response in a number of mental disorders, and may also be noted along with the diagnosis.
For the following categories, in addition to listings of the confirmed or suspected event of abuse or neglect, other codes are provided for use if the current clirtical encounter is to provide mental health services to either the victim or the perpetrator of the abuse or ne- glect. A separate code is also provided for designating a past history of abuse or neglect.
For T codes only, the 7th character should be coded as follows:
A (initial encounter)—Use while the patient is receiving active treatment for the condition (e.g., surgical treatment, emergency department encounter, eval-
D (subsequent encounter)—Use for encounters after the patient has received active treatment for the condition and when he or she is receiving routine care for the condition during the healing or recovery phase (e.g., cast change or re- moval, removal of external or internal fixation device, medication adjustment, other aftercare and follow-up Visits).
Child physical abuse is nonaccidental physical injury to a child—ranging from minor bruises to severe fractures or death—occurring as a result of punching, beating, kicking, biting, shaking, throwing, stabbing, choking, hitting (with a hand, stick, strap, or other object), burning, or any other method that is inﬂicted by a parent, caregiver, or other individual who has responsibility for the child. Such injury is considered abuse regardless of whether the caregiver intended to hurt the child. Physical discipline, such as spanking or paddling, is not considered abuse as long as it is reasonable and causes no bodily injury to the child.
Child Physical Abuse, Confirmed 995.54 (T74.12XA) Initial encounter 995.54 (T74.12XD) Subsequent encounter
Child Physical Abuse, Suspected 995.54 (T76.12XA) Initial encounter 995.54 (T76.12XD) Subsequent encounter 718 Other Conditions That May Be a Focus of Clinical Attention
Other Circumstances Related to Child Physical Abuse
V61 .21 (269.010) Encounter for mental health services for victim of child abuse by parent
V61.21 (269.020) Encounter for mental health services for victim of nonparental child
V15.41 (262.810) Personal history (past history) of physical abuse in childhood
V61 .22 (269.011) Encounter for mental health services for perpetrator of parental child
V62.83 (269.021) Encounter for mental health services for perpetrator of nonparental