ICD-10 APS Codes 2026
Complete guide to coding abuse, neglect, and maltreatment. T74 confirmed codes, T76 suspected codes, Y07 perpetrator codes, and mandatory reporting documentation requirements.
Mandatory Reporting Reminder
Healthcare providers are mandatory reporters in all 50 states. When abuse, neglect, or exploitation is suspected, you must report to Adult Protective Services (for adults) or Child Protective Services (for minors) regardless of whether you are certain.
Failure to report can result in criminal penalties, civil liability, and loss of licensure. Good faith reports are protected by law.
Key Takeaways
- T74 = Confirmed abuse, neglect, or maltreatment
- T76 = Suspected abuse, neglect, or maltreatment
- Y07 = Perpetrator codes (when known)
- 7th character required: A (initial), D (subsequent), S (sequela)
T74: Confirmed Abuse, Neglect, Maltreatment
Use T74 codes when abuse, neglect, or maltreatment has been confirmed through clinical findings, patient disclosure, witness accounts, or investigation results.
| ICD-10 Code | Description | Billable |
|---|---|---|
| Adult Maltreatment - Confirmed | ||
| T74.01XA | Adult physical abuse, confirmed, initial encounter | Yes |
| T74.11XA | Adult psychological abuse, confirmed, initial encounter | Yes |
| T74.21XA | Adult sexual abuse, confirmed, initial encounter | Yes |
| T74.31XA | Adult financial abuse, confirmed, initial encounter | Yes |
| T74.91XA | Unspecified adult maltreatment, confirmed, initial encounter | Yes |
| Child Maltreatment - Confirmed | ||
| T74.02XA | Child physical abuse, confirmed, initial encounter | Yes |
| T74.12XA | Child psychological abuse, confirmed, initial encounter | Yes |
| T74.22XA | Child sexual abuse, confirmed, initial encounter | Yes |
| T74.32XA | Child neglect or abandonment, confirmed, initial encounter | Yes |
| T74.92XA | Unspecified child maltreatment, confirmed, initial encounter | Yes |
7th Character Extension
Replace the "A" with the appropriate encounter type:
- A - Initial encounter (first time treating this episode)
- D - Subsequent encounter (follow-up for same episode)
- S - Sequela (late effects/complications of past abuse)
T76: Suspected Abuse, Neglect, Maltreatment
Use T76 codes when abuse, neglect, or maltreatment is suspected based on clinical findings but not yet confirmed. This is the appropriate code when you've made a mandatory report but investigation is pending.
| ICD-10 Code | Description | Billable |
|---|---|---|
| Adult Maltreatment - Suspected | ||
| T76.01XA | Adult physical abuse, suspected, initial encounter | Yes |
| T76.11XA | Adult psychological abuse, suspected, initial encounter | Yes |
| T76.21XA | Adult sexual abuse, suspected, initial encounter | Yes |
| T76.31XA | Adult financial abuse, suspected, initial encounter | Yes |
| T76.91XA | Unspecified adult maltreatment, suspected, initial encounter | Yes |
| Child Maltreatment - Suspected | ||
| T76.02XA | Child physical abuse, suspected, initial encounter | Yes |
| T76.12XA | Child psychological abuse, suspected, initial encounter | Yes |
| T76.22XA | Child sexual abuse, suspected, initial encounter | Yes |
| T76.32XA | Child neglect or abandonment, suspected, initial encounter | Yes |
| T76.92XA | Unspecified child maltreatment, suspected, initial encounter | Yes |
When to Use Suspected vs. Confirmed
- Use T76 (Suspected): When you have reasonable suspicion but investigation is pending, perpetrator is unknown, or patient denies abuse despite clinical findings
- Use T74 (Confirmed): When patient discloses abuse, perpetrator is identified, law enforcement confirms, or clinical findings are definitive
Y07: Perpetrator Codes
When the perpetrator is known, code additionally using Y07 codes. This is optional but provides valuable data for public health surveillance and epidemiology.
| ICD-10 Code | Perpetrator |
|---|---|
| Y07.0 | Spouse or partner |
| Y07.01 | Husband |
| Y07.02 | Wife |
| Y07.03 | Male partner |
| Y07.04 | Female partner |
| Y07.1 | Parent |
| Y07.11 | Biological father |
| Y07.12 | Biological mother |
| Y07.13 | Adoptive father |
| Y07.14 | Adoptive mother |
| Y07.4 | Other family member |
| Y07.5 | Acquaintance or friend |
| Y07.52 | Healthcare provider |
| Y07.53 | Teacher or instructor |
| Y07.9 | Unspecified perpetrator |
Child Abuse & Neglect Codes
Common Child Abuse Presentations
Physical Abuse Signs
- • Bruises in non-mobile infants
- • Patterned injuries (belt marks, bite marks)
- • Burns in unusual patterns
- • Multiple fractures at different stages
- • Subdural hematoma (shaken baby)
Neglect Signs
- • Failure to thrive without medical cause
- • Severe dental caries (dental neglect)
- • Medical non-compliance
- • Inadequate supervision injuries
- • Poor hygiene, inappropriate clothing
Child Abuse Coding Quick Reference
Confirmed (T74.x2XA)
- T74.02XA - Physical abuse
- T74.12XA - Psychological abuse
- T74.22XA - Sexual abuse
- T74.32XA - Neglect/abandonment
Suspected (T76.x2XA)
- T76.02XA - Physical abuse
- T76.12XA - Psychological abuse
- T76.22XA - Sexual abuse
- T76.32XA - Neglect/abandonment
Elder Abuse & Vulnerable Adult Codes
Types of Elder Abuse
Physical Abuse (T74.01)
- • Unexplained bruises, welts, cuts
- • Fractures inconsistent with history
- • Cigarette burns, restraint marks
- • Over/under medication
Psychological Abuse (T74.11)
- • Emotional distress, withdrawal
- • Fear of caregiver
- • Isolation from friends/family
- • Verbal threats, humiliation
Sexual Abuse (T74.21)
- • Unexplained STIs
- • Genital/anal trauma
- • Torn undergarments
- • Behavioral changes
Financial Abuse (T74.31)
- • Sudden changes in finances
- • Missing valuables
- • Unexplained transfers
- • New "friends" with financial interest
Neglect Signs (Code with T74.01/T76.01 + specific findings)
- • Dehydration without medical cause
- • Malnutrition when food available
- • Untreated pressure ulcers
- • Poor hygiene, unchanged briefs
- • Medication non-administration
- • Unsanitary living conditions
- • Lack of necessary medical devices
- • Unsafe home environment
Documentation Requirements
Essential Documentation Elements
- ✓ Objective clinical findings: Describe injuries in detail (size, shape, color, location)
- ✓ Patient statements: Quote directly in quotation marks
- ✓ History provided: Note who provided history and consistency
- ✓ Photographs: With consent when possible, include in record
- ✓ Confirmed vs. suspected: Clearly state which applies
- ✓ Perpetrator (if known): Document relationship
- ✓ Report filed: Document APS/CPS report including date, time, case number
- ✓ Referrals: Social work, domestic violence resources, law enforcement
Sample Documentation
Chief Complaint: 78-year-old female brought in by daughter for "not acting right"
Physical Exam Findings:
- - Multiple ecchymoses bilateral upper extremities in various stages of healing
- - 3cm x 2cm purple bruise left forearm, consistent with grip marks
- - Stage 2 sacral pressure ulcer 4cm x 3cm with surrounding erythema
- - Appears malnourished, cachectic (BMI 16.2)
Patient Statement: When asked about bruises, patient stated "My son gets rough with me when he's drinking. He grabs my arms when I don't move fast enough."
Assessment: Clinical findings and patient disclosure consistent with confirmed adult physical abuse and neglect.
Mandatory Report: APS report filed today 12/20/2025 at 14:35. Case #2025-xxxxx. Spoke with investigator Jane Doe.
ICD-10: T74.01XA (Confirmed adult physical abuse, initial), T74.91XA (Unspecified adult maltreatment - neglect), Y07.430 (Perpetrator: Adult son)
Mandatory Reporting Requirements
Who Must Report
All healthcare providers are mandatory reporters including:
- • Physicians and residents
- • Nurses (RN, LPN, NP)
- • Physician assistants
- • Social workers
- • Psychologists and therapists
- • EMTs and paramedics
- • Dentists and dental hygienists
- • Medical students/trainees
Child Abuse Reports
- • Report to: Child Protective Services (CPS)
- • National Hotline: 1-800-422-4453
- • Timeline: Immediately or within 24-48 hours
- • Format: Phone report followed by written
Adult/Elder Abuse Reports
- • Report to: Adult Protective Services (APS)
- • National Hotline: 1-800-677-1116
- • Timeline: Immediately or within 24-48 hours
- • Format: Phone report followed by written
Good Faith Protection
All 50 states provide immunity from liability for mandatory reporters who make reports in good faith. You do NOT need to be certain abuse occurred—reasonable suspicion is sufficient. When in doubt, report.
Billing Considerations
Coding Sequence
- Code the specific injury first (e.g., S00.83XA for contusion of face)
- Add the abuse/neglect code (T74 or T76) as secondary diagnosis
- Add perpetrator code (Y07) if known
- Add external cause codes if applicable (place of occurrence, activity)
Example Coding
Patient: 5-year-old with multiple bruises from physical abuse by father
- Primary: S00.83XA - Contusion of other part of head, initial encounter
- Secondary: T74.12XA - Child physical abuse, confirmed, initial encounter
- Secondary: Y07.11 - Perpetrator of maltreatment: Biological father
- Secondary: Y93.89 - Activity, other specified (if applicable)
Frequently Asked Questions
What is the difference between T74 and T76 codes?
T74 codes are used when abuse, neglect, or maltreatment is confirmed. T76 codes are used when abuse, neglect, or maltreatment is suspected but not yet confirmed. The distinction is important for legal documentation and mandatory reporting.
When should I use abuse and neglect ICD-10 codes?
Use these codes when clinical findings suggest abuse, neglect, or maltreatment in any patient. This includes unexplained injuries, malnutrition in dependent adults, signs of physical or psychological abuse, or sexual assault. Healthcare providers are mandatory reporters in all 50 states.
What is the ICD-10 code for elder abuse?
Elder abuse uses adult maltreatment codes: T74.01XA (confirmed adult physical abuse), T74.11XA (confirmed adult psychological abuse), T74.21XA (confirmed adult sexual abuse), T74.91XA (confirmed unspecified adult maltreatment). Add appropriate 7th character for encounter type.
Do I need to code the perpetrator for abuse cases?
Yes, when known, code the perpetrator using Y07 codes: Y07.0 (spouse/partner), Y07.1 (parent), Y07.4 (other family member), Y07.5 (acquaintance/friend), Y07.9 (unspecified). This is optional but provides important data for public health tracking.
What documentation is required for abuse coding?
Document: (1) Clinical findings suggesting abuse/neglect, (2) Patient or witness statements, (3) Whether confirmed or suspected, (4) Perpetrator if known, (5) Mandatory report filed, (6) Social work/APS referral. Use objective language and quote patients directly when possible.
What is the 7th character requirement for T74/T76 codes?
T74 and T76 codes require a 7th character: A (initial encounter), D (subsequent encounter), or S (sequela). Most new presentations use "A". Follow-up visits for the same episode use "D". Long-term effects of past abuse use "S".
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