ICD-10 Code T74.92XD: Unspecified child maltreatment, confirmed

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Key takeaways

T74.92XD is a billable ICD-10-CM code for confirmed child maltreatment at a follow-up encounter, unlike T74.92XA for initial treatment.

T74 codes require explicit provider documentation of confirmation. Suspected maltreatment uses T76 codes instead.

Report associated injury codes alongside T74.92XD, plus a perpetrator code from the Y07 category where applicable.

Excludes1 blocks T74.92XD and T76.92XD on the same claim, while Excludes2 allows T74.92XD with the Z62.81x history codes.

Practice management software like Pabau can prompt for the confirmation language and the associated injury codes before a note closes.

ICD-10 Code T74.92XD is the billable ICD-10-CM diagnosis code for unspecified child maltreatment, confirmed, subsequent encounter. Coders assign it when the medical record carries a provider’s explicit confirmation of maltreatment and the visit follows treatment already rendered.

The code is valid for the 2026 fiscal year, effective October 1, 2025. Two other codes usually ride with it on the claim. Report any associated injury, and add a perpetrator code from the Y07 category where the documentation supports one.

ICD-10 Code T74.92XD: Definition and billable status

ICD-10 Code T74.92XD is a billable, specific ICD-10-CM code. It reports unspecified child maltreatment confirmed by the treating provider, at a subsequent encounter.

“Subsequent encounter” means the patient has already received active treatment for the maltreatment. The current visit covers ongoing management, healing monitoring, or follow-up care.

The code sits in the T74 category within ICD-10-CM Chapter 19 (Injury, Poisoning and Certain Other Consequences of External Causes).

It has been part of the code set since ICD-10-CM took effect in the United States in October 2015. It carries into the FY2026 edition unchanged, so what is new each year is the annual code-set revision rather than this code.

The CMS ICD-10-CM coding resources publish the current files each fiscal year. Coders can verify the descriptor and the tabular notes in the CDC/NCHS ICD-10-CM web tool.

Understanding the 7th character: A, D, and S in T74.92X

The 7th character in ICD-10-CM injury and external cause codes marks the phase of care. Three options apply to T74.92X, each one a distinct clinical scenario.

Using the wrong character is a common audit trigger, especially confusing A (initial) with D (subsequent) after treatment has begun.

A practical rule settles most cases. If the provider is seeing the child for the first time to treat the confirmed maltreatment, use T74.92XA. Once that treatment is underway and the child returns, every later visit uses T74.92XD.

The sequela character S applies only to a lasting complication. That covers a psychological or physical condition persisting after the maltreatment is no longer active. The same A/D/S logic governs every injury code in ICD-10-CM Chapter 19, and payers deny claims where the 7th character contradicts the documented encounter type.

Confirmed vs suspected child maltreatment: T74 vs T76

Confirmed maltreatment uses T74 codes. Suspected maltreatment uses T76 codes. The ICD-10-CM Official Guidelines for Coding and Reporting address the distinction explicitly in Section I.C.19. The threshold for confirmed coding is explicit provider documentation, not a coder’s clinical judgment.

The distinction carries compliance consequences. Coding T74.92XD without documented provider confirmation is an exposure point in an audit. If the note says “suspected,” “possible,” or “consistent with,” the coder must use T76 rather than T74. Only explicit provider confirmation language in the record makes T74 correct.

The two decisions stack, and the diagram below shows how they resolve to a single code.

Code hierarchy and related T74 sibling codes

T74.92XD sits inside a structured hierarchy. Knowing where it sits helps coders move to a more specific code once the type of maltreatment is documented. The hierarchy runs from broadest to most specific:

• T74: Adult and child abuse, neglect and other maltreatment, confirmed
• T74.9: Unspecified maltreatment, confirmed
• T74.92: Unspecified child maltreatment, confirmed
• T74.92X: Placeholder X added for 7th character extension
• T74.92XD: Unspecified child maltreatment, confirmed, subsequent encounter

When the type of maltreatment is known, a more specific sibling code within T74 applies. Use T74.92XD only when the type is undocumented or cannot be specified.

The full family sits alongside every other diagnosis code in our ICD-10-CM code library. Check the sibling descriptor there before you assign it.

Excludes notes: When this code is the wrong choice

Two excludes notes govern T74.92XD. Each marks a scenario where T74.92XD is the wrong code. That holds even when child maltreatment is clinically relevant to the visit.

• Excludes1: T76.92XD (unspecified child maltreatment, suspected, subsequent encounter). Excludes1 is a hard exclusion, so the two codes cannot be reported together. When the record supports suspicion rather than confirmation, T76.92XD applies instead.
• Excludes2: Z62.81x (history of child maltreatment). Excludes2 is a soft note, so T74.92XD and Z62.81x can appear on the same claim when both are currently relevant. Z62.81x reports a past history of maltreatment, while T74.92XD reports a current confirmed episode.

Misreading the Excludes2 note as a prohibition is a common documentation mistake. The history code and the active maltreatment code serve different functions. Both can appear in the same encounter when the record documents each one.

Documentation requirements for confirmed child maltreatment coding

Coding T74.92XD requires explicit provider confirmation in the medical record. The coder cannot infer confirmation from physical findings alone. Five documentation elements support a confirmed maltreatment code:

• Explicit provider language: The note must say “confirmed,” “consistent with confirmed maltreatment,” or state the confirmed diagnosis directly. Terms like “suspected,” “rule out,” or “possible” point to T76.
• Type of maltreatment: Document whether the maltreatment is physical, sexual, psychological, or neglect. If the type cannot be specified, T74.92XD applies. If it can, use the appropriate sibling code.
• Associated injuries: Document any injuries resulting from the maltreatment. ICD-10-CM requires additional codes for those injuries, so the record has to support them.
• Encounter type: The record must show whether this is the initial treatment visit or a follow-up. For T74.92XD, it should reflect treatment already rendered at a prior visit.
• Perpetrator relationship: Document the perpetrator relationship where possible. This supports perpetrator coding from the Y07 category.

Structured digital intake forms can carry prompts that capture this documentation at the point of care. That reduces the risk that a coder later finds too little record support for a T74 versus T76 call.

Mandatory reporting obligations for confirmed maltreatment

Confirmed child maltreatment triggers mandatory reporting obligations in every US state. The reporting clock usually starts when a provider confirms maltreatment in the clinical documentation. Coding T74.92XD therefore records a clinical determination that also carries a legal dimension.

Mandatory reporting laws vary by state on who counts as a mandated reporter, how fast a report is due, and which agency receives it. The Child Welfare Information Gateway (HHS) maintains state-by-state summaries of the statutes. Never assume one universal rule applies everywhere. Verify the law that applies to each practice location.

HIPAA permits providers to disclose protected health information for mandatory reporting without patient authorization, under 45 CFR 164.512(b). The exception is narrowly scoped. It authorizes disclosure to the reporting agency only, not general release of the patient’s record.

Practices where several staff members handle maltreatment documentation should write that boundary into their policies.

The reporting obligation rests with the provider, not the coder. The coder’s role is accurate code assignment. Compliance and reporting decisions rest with clinical and administrative leadership, and documented policies specific to maltreatment reporting reduce exposure.

CPT codes commonly paired with T74.92XD

T74.92XD is a diagnosis code. It pairs with the CPT procedure codes that describe the services rendered at the encounter. Most follow-up maltreatment visits are evaluation and management encounters, which is what the table below reflects.

Note that 96161 is the caregiver-focused instrument. The patient-focused version is 96160, and swapping the two is a frequent cause of a rejected line item.

Payer policies on which CPT codes pair with T74.92XD vary. Verify payer-specific coverage edits before submitting. This matters most when evaluation and management codes are billed alongside behavioral health services at the same encounter.

Common coding errors and how to avoid them

Four error patterns account for most denials and audit findings on T74.92XD claims. Each one reflects a misunderstanding of the confirmed/suspected distinction, the 7th character system, or the Code Also requirements.

• Using T74 when the record supports only T76. If the provider’s note says “suspected” or “possible” maltreatment, T76.92XD is correct. Coders sometimes upgrade to T74 on the strength of physical findings or clinical intuition. The guidelines require explicit provider confirmation language.
• Wrong 7th character. Coding T74.92XA on a follow-up visit puts the coded encounter type at odds with the service dates. So does T74.92XD on the first treatment visit. Payers and auditors compare encounter dates to 7th character designations.
• Omitting associated injury codes. ICD-10-CM requires additional codes to identify associated injuries when they exist. Submitting T74.92XD alone when injuries are documented sends an incomplete claim into denial management.
• Confusing Excludes1 and Excludes2 notes. Excludes1 (T76.92XD) is a hard exclusion, so T74.92XD and T76.92XD cannot appear together. Excludes2 (Z62.81x) is a soft note, so those two can coexist when both are documented and currently relevant.

The AAPC ICD-10-CM lookup lists the tabular notes, including the excludes annotations, so coders can spot these issues before submission.

Applicable To notes and clinical synonyms

The Applicable To section lists the clinical terms that fall within the scope of T74.92XD. These are inclusions, not separate codes. Each applies at a subsequent encounter for confirmed child maltreatment, unless a more specific sibling code fits:

• Confirmed child abuse, unspecified type, follow-up visit
• Confirmed child maltreatment NOS (not otherwise specified), subsequent encounter
• Confirmed unspecified maltreatment of child, subsequent encounter

When the record specifies the maltreatment type, use the matching sibling code from the T74.X2 series rather than T74.92XD.

The “unspecified” designation applies only where the type cannot be determined from the available documentation. The CDC/NCHS ICD-10-CM web tool carries the current year’s full Applicable To list under T74.92.

How Pabau handles sensitive diagnosis codes

A code like T74.92XD creates three workflow demands at once:

• Documentation thorough enough to support the confirmed designation.
• Associated injury and perpetrator codes reported alongside the primary code.
• A clean transmission to the payer with the code pair intact.

A standalone lookup tool verifies the descriptor and stops there. It enforces none of the three once the coder closes the tab.

Practice management software like Pabau keeps the three in one workflow. Its claims software for billers supports structured clinical documentation and claim submission for sensitive maltreatment codes.

Mandatory field prompts inside the clinical note capture the associated injury documentation and the encounter type at the point of care. That shortens the back-and-forth between coder and provider on high-scrutiny diagnoses.

Pabau connects to the Claim.MD clearinghouse for US submission, which reaches thousands of US payers. A claim carrying T74.92XD with its associated injury and perpetrator codes goes out in one pass.

Eligibility verification and electronic remittance advice come back into the same system, which removes the retyping between the chart and a separate billing portal.

Streamline sensitive diagnosis coding with Pabau

Pabau’s documentation prompts and claims tools capture the confirmation language and the associated codes at the point of care. See how that works in your practice.

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Conclusion

Accurate coding of T74.92XD comes down to three elements landing in the same claim. The record has to carry explicit provider confirmation language. The 7th character has to match the encounter type. Every required associated code has to be present.

When one of the three is missing, the denial arrives weeks later. The fix is a documentation query the practice could have run at the visit. The trade-off worth remembering is that a query to the provider costs minutes, while a reworked maltreatment claim costs days.

Build the confirmation language and the Code Also prompts into the note template, and the coding decision stops being a judgment call after the fact. Book a demo to see how Pabau captures that detail at the point of care and submits the full code set in one claim.

Continue your research

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