ICD-10-CM Codes: How Medical Documentation Can Improve Health Care for Trafficking Victims

Gaps in previous International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes failing to “capture the profoundly exploitive nature of [human] trafficking” have led to the inclusion of trafficking-specific codes in the 2019 ICD-10-CM update.¹

In a policy forum article published in the AMA Journal of Ethics,¹ Wendy L. Macias-Konstantopoulos, MD, MPH, a faculty member at the Department of Emergency Medicine at Massachusetts General Hospital in Boston, described the first human trafficking-specific diagnostic codes approved for the 2019 ICD-10-CM update. Existing abuse codes fail to capture the myriad forms of abuse and violence perpetrated against trafficked individuals. As such, the 2019 ICD-10-CM code updates are necessary to improve clinical care, data tracking, and resource linkage for victims of trafficking.

The Trafficking Victims Protection Act of 2000 defines “severe forms of trafficking in persons” as: (1) commercial exploitation of an adult by “provable” force, fraud, or coercion; or, (2) commercial sexual exploitation of an individual under the age of 18.² Trafficking has profound effects on the physical and psychological health of victims; they are at increased risk for violence-related injuries, sexually transmitted infections, and many communicable and chronic diseases.³ Trafficking is also associated with occupational injuries among those exploited for labor, including exposure to harmful chemicals and falls from heights.⁴

The psychological effects of trafficking have been described as “tantamount to those observed among survivors of torture.”⁵ Research indicates that trafficking victims often have access to healthcare. According to a 2017 survey, 88% of trafficked survivors reported having been cared for by a health professional while being trafficked. However, none surveyed indicated that they received assistance in escaping their captors.⁶ These data underscore a need for improved care linkage for trafficking victims.

The current iteration of the ICD-10-CM does not have abuse codes that capture the “varying degrees of…trauma experienced by trafficked individuals,” Dr Macias-Konstantopoulos wrote. Although there are abuse codes for interpersonal abuse and violence, the commercial aspect of trafficking is uniquely devastating for psychological health. The commercialization of victims strips them of “autonomy and…human rights, [thus leading] to [an] extreme level of…trauma.”

The needs of this patient population are extensive and complex, Dr Macias-Konstantopoulos added, meriting the 2019 ICD-10-CM update that includes trafficking-specific codes. Through ICD-10-CM codes, medical professionals can create a comprehensive database with information about risk factors and appropriate care strategies for each condition. If comprehensive documentation is “achieved…over time,” data can be used to inform healthcare policy and resource allocation. With specific ICD-10-CM human trafficking codes, healthcare professionals can more easily monitor certain risk factors and develop appropriate care plans. ICD-10-CM data can also be used to better identify which communities and individuals are affected disproportionately by trafficking.

Medical documentation is essential to health care. The 2019 ICD-10-CM update will introduce codes that capture appropriately the full scope of trauma experienced by trafficking victims. Through these codes, the medical community can better allocate treatment and resources to those in need.

References

1. Macias-Konstantopoulos WL. Diagnosis codes for human trafficking can help assess incidence, risk factors, and comorbid illness and injury. AMA J Ethics. 2018;20(12):E1143-E1151.
2. Victims of Trafficking and Violence Protection Act of 2000, Pub L No. 106-386, 114 Stat 1464.
3. Hossain M, Zimmerman C, Abas M, Light M, Watts C. The relationship of trauma to mental disorders among trafficked and sexually exploited girls and women. Am J Public Health. 2010;100(12):2442-2449.
4. Macias-Konstantopoulos W, Ma ZB. Physical health of human trafficking survivors: unmet essentials. In: Chisolm-Straker M, Stoklosa H, eds. Human Trafficking is a Public Health Issue: A Paradigm Expansion in the United States. Cham, Switzerland: Springer International; 2017:185-210.
5. Organization for Security and Co-operation in Europe Office of the Special Representative and Co-ordinator for Combating Trafficking in Human Beings; Ludwig Boltzmann Institute of Human Rights; Helen Bamber Foundation. Trafficking in Human Beings Amounting to Torture and Other Forms of Ill-Treatment. https://www.osce.org/cthb/103085. June 25, 2013. Accessed January 14, 2019.
6. Lederer LJ, Wetzel CA. The health consequences of sex trafficking and their implications for identifying victims in healthcare facilities. Ann Health Law. 2014;23(1):61-91.