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v1.0.0
ICD-10 Guide
DiagnosesAssault By Another Person

Assault By Another Person

ICD-10 Coding for Assault by Another Person(T74.12XA, Y04.2XXA)

PRIMARY SPECIALTYEmergency Medicine
COMPLEXITYHigh
LAST UPDATED09/15/2025
Sam Tuffun, PT, DPT
Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Assault By Another Person?
Essential facts and insights about Assault by Another Person

Key Clinical Considerations:

  • Presence of physical injuries such as bruises, lacerations, fractures, or contusions resulting from an assault.
  • Psychological symptoms such as anxiety, depression, or PTSD may be present following the incident.
  • Physical examination may reveal signs of trauma, including swelling, tenderness, or deformities.
  • Imaging studies (e.g., X-rays, CT scans) may be necessary to assess for internal injuries or fractures.
  • Severity of injuries may be classified based on the extent of physical harm, ranging from minor to life-threatening.

Clinical Information

Clinical Criteria & Documentation Requirements

  • Complete and accurate medical record documentation of the incident, including date, time, and circumstances of the assault.
  • Specific terminology such as 'assault', 'physical injury', and 'trauma' must be documented.
  • Examples include: 'Patient presents with lacerations to the forearm due to an assault.'
  • Documentation must establish medical necessity for treatment provided, including rationale for interventions.
  • Quality measures may include documentation of follow-up care and mental health assessments.

Coding Guidelines

Usage Guidelines & Examples

  • Use T74.12XA for initial encounter of assault with physical injuries; Y04.2XXA for assault by another person.
  • Do not use these codes for self-inflicted injuries or injuries resulting from accidents.
  • Compare with codes for domestic violence (e.g., T74.11XA) which may have different implications.
  • Common errors include misclassifying the nature of the injury or failing to document the assault context.
  • In complex cases, ensure to differentiate between types of assaults and document all relevant details.

Code Exclusions

Important Exclusions

  • Excludes self-inflicted injuries (e.g., T14.91) and injuries from accidents.
  • Alternative codes for excluded conditions may include those for domestic violence or neglect.
  • Conditions are excluded to ensure accurate representation of the nature of the injury.
  • Common mistakes include misidentifying the source of injury or failing to document the assault context.
  • Related but distinct conditions include domestic violence and accidental injuries.

Related ICD-10 Codes

Primary Codes
T74.12XA
Assault by another person, initial encounter
Y04.2XXA
Assault by another person, initial encounter
Ancillary Codes
Y04.2XXA
Differential Codes
T76.12XA

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Emergency Medicine

Specialty Applications

  • Applies to patients with injuries resulting from physical assaults.
  • Patient populations include all ages, with particular attention to vulnerable groups (e.g., children, elderly).
  • Clinical settings include emergency departments, urgent care, and inpatient facilities.
  • Specialty-specific applications may involve emergency medicine, psychiatry, and trauma surgery.
  • Treatment contexts include immediate care for injuries and long-term psychological support.

Coding Complexity

High Complexity

This diagnosis requires careful attention to:

  • Comprehensive clinical documentation
  • Accurate code selection based on clinical criteria
  • Proper exclusion considerations
  • Specialty-specific coding guidelines

Documentation

Documentation Templates

Template 1

Template: 'Patient diagnosed with assault-related injuries based on physical examination findings.'

Template 2

Template: 'Clinical presentation consistent with assault including lacerations and contusions.'

Template 3

Template: 'Diagnostic criteria for trauma met as evidenced by imaging results showing fractures.'

Template 4

Template: 'Treatment plan initiated for assault injuries with sutures and pain management.'

Template 5

Template: 'Follow-up care for assault-related trauma including mental health evaluation.'

Billing Information

Billing Considerations

  • Ensure proper documentation for billing
  • Verify code specificity requirements
  • Check for any additional codes needed
  • Review payer-specific guidelines

Common Issues

  • Insufficient clinical documentation
  • Incorrect code selection
  • Missing supporting diagnoses
  • Timing and frequency documentation

Frequently Asked Questions

What documentation is required for this diagnosis?

Detailed documentation of the assault incident, including injuries and treatment provided.

How does this differ from similar diagnoses?

Key differences include the source of injury (assault vs. self-inflicted) and the context of the event.

What are common billing considerations?

Ensure accurate coding to reflect the nature of the injury for optimal reimbursement.

What procedures are typically associated?

Related CPT codes may include those for wound care, imaging, and psychological evaluations.

Are there any quality reporting implications?

Quality measures may include tracking follow-up care and mental health assessments post-assault.