By NANCY FRAZIER O'BRIEN
When some people hear about a new ICD-10 code, their thoughts go to medical billing and reimbursement. But for two leaders at Catholic Health Initiatives, several new codes that will take effect in October represent an opportunity to shine more light on the scourge of human trafficking.
Colleen Scanlon, CHI senior vice president and chief advocacy officer, and Laura Krausa, CHI system director of advocacy, worked with the American Hospital Association and Massachusetts General Hospital's Human Trafficking Initiative to convince a joint committee of the Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services to add new diagnosis codes for human trafficking involving forced labor and sexual exploitation of adults and children.
The codes are to be added to the International Classification of Diseases 10th Edition Clinical Modification (ICD-10-CM) used in the United States.
"The codes are used by clinicians to classify diseases, injuries and symptoms and that helps in the design of appropriate plans of care to respond to that individual," Scanlon said. "But there was no specific code for human trafficking, and the existing abuse codes are insufficient to capture the complexity of issues that a person who is trafficked may experience."
By adding the new codes, "it continues to raise awareness of this issue among health professionals," Krausa said. Current codes can be used to identify various forms of abuse, but they are insufficient for the identification of human trafficking. This type of violence is tragically unique in that the resulting physical, psychological and emotional trauma is extremely complex, and can require specialized, intensive and long-term care and services, she said.
The new codes also will allow for better tracking of "the prevalence of this reality," Scanlon said.
The International Labor Organization in September published estimates that 40 million people are trafficked worldwide. According to the proposal submitted to the ICD-10 Coordination and Maintenance Committee, the number of human trafficking victims may be underreported due to the clandestine nature of human trafficking.
"A lot of individuals who are trafficked don't understand they are being trafficked," Krausa said. Even if they do, their circumstances often are complicated by immigration issues, drug abuse or other factors that make them unwilling to come forward, she said.
Human trafficking is defined as the act of recruiting, transporting, transferring, harboring or receiving persons by means of threat, force, coercion, abduction, fraud, deception or abuse of power for the purpose of sexual exploitation, forced labor, slavery or slave-like practices, or removal of an organ.
"Better data will mean that we can move the needle on prevention efforts," according to a CHI news release. "As we help to uncover the extent of this crisis, we can make the case for needed resources and draw greater attention to this affront on human rights and dignity."
Studies have shown that "a high percentage of persons who are trafficked come into a clinical care setting" at some point, Scanlon said. "There is an enormous opportunity (in health care) to appropriately respond to these individuals in a professional and caring way."
The proposal noted that the new codes represent "a starting point to capture information needed in order to better understand this type of violence" and acknowledged that more specific codes might be needed in the future.
"Tracking confirmed and suspected cases in the health care system provides another source for data collection that can assist in the development of public policy and prevention efforts, as well as support the systemic development of an infrastructure for services and resources," the proposal added.
Although CHI, the AHA and Massachusetts General took the lead on the new codes, various other organizations provided input, comments and letters of support for the initiative, including CHA and many other Catholic health systems, Scanlon said.
An important next step will be educating health care professionals about the new codes and the problem of human trafficking. Educational resources will be important to the successful application of these new codes.
"Many useful resources already exist that address human trafficking, and over the next months efforts will be underway to create even more," Scanlon said. "Many organizations and people will be contributing to developing such resources."
CHI's work on the human trafficking codes is part of a comprehensive, system-wide violence-prevention initiative by the Englewood, Colo.-based health system that also focuses on problems ranging from youth dating behavior and school violence to cyberbullying, gang violence and child and elder abuse.
As Catholic Health World went to press, Krausa was scheduled to represent CHI at the AHA Leadership Summit in late July at a workshop on "Hospitals Against Violence: Effective Violence Prevention Strategies."
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