Lawrence A. Allen, MBA, CPC
This presentation is based on the presenter s perspective and views and does not represent official policy, guidance, or opinions of the Department of Defense (DoD) or the U.S. Air Force. The presenter has no financial conflicts of interest related to this presentation.
Overview of the Military Health System (MHS) Similarities and differences between MHS coding and industry coding DoD Coding Guidance Current challenges in DoD coding
TRICARE Payor system for civilian care of military beneficiaries Military Health System (MHS) System of military medical centers, hospitals, and clinics Estimated 1.2 million outpatient encounters each month in the MHS
24,475 Outpatient Visits 222 Surgery Procedures 136 Same Day Surgeries 86 Inpatients 29 Babies Delivered 168 Inpatient Admissions 61,578 Prescriptions Filled 31,601 Lab Procedures 4,637 Radiology Procedures 6,306 Dental Encounters Air Force Medical Service Fixed Facilities: 41,986 clinic visits 374 patients admitted 1,214 patient beds occupied 26,600 dental procedures 5,879 immunizations 64 births 12,494 radiology procedures 54,048 outpatient pharmacy prescriptions 50,420 laboratory procedures Army Medical Department
The majority of MHS coding standards are the same as in the civilian healthcare industry Mirrors CMS as much as possible Same industry references consulted AAPC and AHIMA certified coders Combination of civil service and contract coders
Military unique medical services and requirements create coding requirements not seen in civilian industry Organizational structure, government regulations, etc. creates a system that is both professional and institutional based Congressional and/or DoD Health Affairs mandated policy Unique requirements involving coding and reporting productivity
Specific diagnosis codes are altered in order to capture specific military-related conditions as mandated by DoD Health Affairs aka Extender Codes Captures specific conditions such as traumatic brain injury (TBI) Hearing conservation Case management Education (V65.49_x) Physical exams (V70.5_x)
V70.5_1 Aviation Examination V70.5_D DD2795. Pre-Deployment Assessment: Documented on V70.5_E Initial Post-Deployment Assessment: Documented on DD2796 V70.5_F Post Deployment Health Reassessment (PDHRA): Documented on DD2900. V70.5_G Global War on Terrorism (GWOT)/Wounded Warriors (WW). To be used if the individual is designated a Wounded Warrior. For TBI coding, See Appendix G. V49.89_3 Case Management Continue V15.52_7 (Personal History of TBI, Not GWOT Related, Mild (Glasgow Coma Scale 13-15), LOC < 1 Hr, Post Trauma Amnesia < 24 Hr) V65.49_8 Mental Health education
Certain CPT codes used differently from civilian industry due to organizational, IT constraints Example: 91999 Used to indicate the institutional component of an Ambulatory Procedure Visit (APV) for billing purposes Unique use of certain HCPCS codes for reporting purposes Example: Reporting G9002 and T1016 for case management services
MHS Coding Guidelines http://www.tricare.mil/ocfo/bea/ubu/coding_guidelines.cf m Provides coding guidance for military specific requirements and needs Guidelines developed by Service Representatives Air Force (Air Force Medical Operations Agency, aka AFMOA) Army (Patient Administration Systems and Biostatistical Activity, aka PASBA) Navy (Bureau of Medicine, aka BUMED) Types of Coding Guidance Professional Institutional Deployed
ICD-10 Preparation Systems Issues Electronic Medical Records Patient-Centered Medical Homes (PCMH) Case Management Observation Telemedicine Behavioral Health Programs Joint Operations Doing More With Less
DoD level contract with 3M to provide online training to coders, providers, and other stakeholders Services plans for additional military-specific training and guidance Some DoD extender diagnosis codes will still be required
Challenges in maintaining connectivity and transmittal of information between systems due to: Firewalls AHLTA (EMR) CHCS CCE Use of external databases for documentation Service specific custom IT programs Current limitations don t allow MHS to separate professional/institutional bills which can cause problems
Main EMR (AHLTA) and external database use Template proliferation Electronic signatures Copy/Paste
Proliferation of PCMH model in the MHS has challenged coding guidance in terms of: Defining group practices Defining new vs. established patients
Expansion of case management beyond what is seen in the civilian industry Behavioral Health PCMH Warrior Treatment Unit (Rehabilitation and complex care for wounded soldiers) Workload capture and reporting issues creating coding issues
Observation care is provided in the MHS but is currently difficult to code properly due to: IT limitations Organizational structure Workload reporting requirements
Explosion of telemedicine initiatives Telemedicine as defined by CPT Secure messaging Telebehavioral Health
Multiple levels of screenings for PTSD, depression, etc. by different providers Multiple group same-day treatment sessions Telebehavioral Health Expansion of Partial Hospitalization Programs and Intensive Outpatient Programs for TBI, PTSD, pain
JTFCAPMED Joint Task Force National Capital Region Medical Command Integration of Air Force, Army, and Navy medical services in the DC area SAMMC San Antonio Military Medical Center Integration of Air Force and Army medical services DoD/VA Sharing Agreements
Few coders, large number of encounters Demands on MHS coders Coding Educating providers Reports Budget limitations