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Briefing: Deployment-Related Coding . Date: 24 March 2010 Time: 1110 – 1200. Objectives. Definition of Deployment DoD Healthcare Related to Deployments Identify Healthcare Needs Caused by Deployments

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Briefing: Deployment-Related Coding

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Briefing deployment related coding l.jpg

Briefing:Deployment-Related Coding

Date: 24 March 2010

Time:1110 – 1200


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Objectives

Definition of Deployment

DoD Healthcare Related to Deployments

Identify Healthcare Needs Caused by Deployments

Use of DoD Extender Codes to Root Codes V70.5_x

Enables Differentiation of types of Deployment Health Assessments


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Deployment Definition

Deployment is defined as any current or past event or activity that relates to duty in the armed forces that involves an operation, location, command, or duty that is different from the military member’s normal duty assignment.

(Reference: PDH Guidelines)


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Deployment Criteria

Service member leaves the physical locale of parent command

Enter an environment for operational deployment

Stationed in a hostile territory

(Reference: PDH Guidelines)


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Deployment Codes

V70.5_4Pre-Deployment Related Encounter: Encounter related to a projected deployment. Could include family members experiencing a condition related to the projected deployment of the sponsor or other family member. Excludes V70.5_D which codes the encounter documented on the DD2795.

V70.5_5Intra-Deployment encounter: Any deployment-related encounter performed while individual (active duty [AD], contractor, etc.) is deployed. Could include family members experiencing a condition related to the deployment of the sponsor or other family member.

V70.5_6Post-deployment related encounter: Specifically performed because an individual was deployed. Could include family members experiencing a condition related to a prior deployment of the sponsor or other family member. Excludes V70.5_E and V70.5_F which code the encounters documented on the DD2796 and DD2900.


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Deployment Assessments

V70.5_DPre-Deployment Assessment: Documented on DD2795.

V70.5_EInitial Post-Deployment Assessment: Documented on DD2796.

V70.5_FPost Deployment Health Re-assessment (PDHRA): Documented on DD2900.


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Root Code V70.5 with DoD Extender

Codes V70.5_4/5/6/D/E/F are to be used as a primary diagnosis for an exam, assessment, or screening encounter when the purpose of the encounter is specifically deployment related.


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Deployment Codes

Codes V70.5 4/5/6 may be used in the second, third, or fourth position to indicate some aspect or the encounter is deployment related.

Codes V70.5_4/5/6/D/E/F will be used in the subsequent diagnosis positions when the primary purpose of the encounter was not specifically deployment related, but “deployment related” concerns were found that should be coded as additional diagnoses.


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Pre-Deployment Related Encounter

V70.5_4 Encounter related to a projected deployment. Could include family members experiencing a condition related to the projected deployment of the sponsor or other family member. Excludes V70.5_D which codes the encounter documented on the DD2795.

Example: Symptoms, Pre-Deployment-Related New onset bed wetting of 5-yr-old boy whose mother is about to leave on 12 month deployment.788.36 (nocturnal enuresis)V70.5_4


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Intra-Deployment Encounter

V70.5_5 Any deployment-related encounter performed while individual (active duty [AD], contractor, etc.) is deployed. Could include family members experiencing a condition related to the deployment of the sponsor or other family member.

Example 1: 13-yr-old girl with significant weight loss. Mother suspects concern is related to father’s current deployment to Iraq.783.21(abnormal weight loss)

Example 2: 23-yr-old Marine developed poison ivy rash while deployed.692.6 (contact dermatitis caused by plants)


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Post-Deployment Encounter

V70.5_6 Specifically performed because an individual was deployed. Could include family members experiencing a condition related to a prior deployment of the sponsor or other family member. Excludes V70.5_E and V70.5_F which code the encounters documented on the DD2796 and DD2900.

Example 1: Asymptomatic Concerned, Post-Deployment-Related AD soldier recently returned from deployment. Pregnant wife has concerns about depleted uranium exposure. V65.5 (person with feared complaint)

Example 2: 49-yr-old retired beneficiary has been evaluated over 3 months (5 visits) for intermittent joint pain, intermittent vertigo and severe fatigue. Patient says he believes he was exposed to something in Kuwait on mission two years ago. Work-up to date is complete, but negative.799.8 (other ill-defined conditions and unknown causes of morbidity)


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Pre-Deployment Assessment

  • V70.5_D Documented on DD2795. Collection of this information is for military readiness to ensure assessment is done prior to deployment.

    • 1. The DD Form 2795 is determined to be a negative assessment and is reviewed only by a non-privileged provider, and the form is filed. Code the ICD-9 code V70.5_D under the technician’s name.

    • 2. The privileged provider reviews the form in a face to face encounter and makes a final medical disposition. Code E&M 99420 and the ICD-9 code V70.5_D.

    • 3. The provider identifies, addresses and documents a medical problem. The encounter should be coded based on documentation and code V70.5_D as primary and other diagnoses as additional


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Initial Post-Deployment Assessment

  • V70.5_EDocumented on DD2796.

    • 1. If the purpose of the encounter is to complete the DD Form 2796 by the privileged provider and no medical conditions are found, code V70.5_E first and use 99420 for the E&M.

    • 2. If the purpose of the encounter is to complete the DD Form 2796 and assessment and medical evaluation identifies medical conditions requiring treatment, code V70.5_E first and then code appropriate ICD9 codes. Use 99420 for the E&M code and additional E&M based on the documentation with modifier 25.

    • 3. If, during an encounter for other reasons, it is determined that a required DD Form 2796 has not been completed, code the appropriate ICD9 code for the primary reason for the visit and use code V70.5_E in the first four diagnosis codes. Use appropriate office visit E&M code based on the documentation.


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Initial Post-Deployment Assessment

Example: An AD member who recently returned from deployment presents to the clinic for an evaluation of a rash. The provider evaluates the patient and diagnoses the patient with cutaneous leishmaniasis related to his recent deployment to Iraq. The primary diagnosis in this scenario is 085.9 (unspecified cutaneous leishmaniasis) and the secondary code would be V70.5_6. If during this encounter the provider discovers that the patient has not completed his DD2976 and has the patient complete it, then V70.5_E will be added as an additional diagnosis.


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Post Deployment Health Reassessment (PDHRA)

V70.5_FDocumented on DD2900.

Encounters involving completion of the DD Form 2900, will be coded in the same manner as specified for DD Form 2796 Initial Post-Deployment Assessment, substituting V70.5_F in place of V70.5_E


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ICD-9-CM New Codes Effective 1 October 2009

E000.0 Civilian activity done for income or pay

Civilian activity done for financial or other compensation

E000.1 Military activity

E000.8 Other external cause status

Off-duty activity of military personnel

E000.9 Unspecified external cause status

Note: A code from category E000 may be used in conjunction with the external cause code(s) assigned to a record to indicate the status of the person at the time the event occurred. A single code from category E000 assigned for an encounter.


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ICD-9-CM New Codes Effective 1 October 2009

E990.1 Injury due to war operations from flamethrower

E990.2 Injury due to war operations from incendiary bullet

E990.3 Injury due to war operations from fire caused indirectly from conventional weapon

E991.4 Injury due to war operations by fragments from munitions

E991.5** Injury due to war operations by fragments from person-borne improvised explosive device [IED]

E991.6** Injury due to war operations by fragments from vehicle-borne improvised explosive device [IED]


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ICD-9-CM New Codes Effective 1 October 2009

E991.7** Injury due to war operations by fragments from other improvised explosive device [IED]

E991.8 Injury due to war operations by fragments from weapons

E992.0 Injury due to torpedo

E992.1 Injury due to depth charge

E992.2 Injury due to marine mines

E992.3 Injury due to sea-based artillery shell

E992.8 Injury due to war operations by other marine weapons

E992.9 Injury due to war operations by unspecified marine weapon


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ICD-9-CM New Codes Effective 1 October 2009

E993.0 Injury due to war operations by aerial bomb

E993.1 Injury due to war operations by guided missile

E993.2 Injury due to war operations by mortar

E993.3** Injury due to war operations by person-borne improvised explosive device [IED]

E993.4** Injury due to war operations by vehicle-borne improvised explosive device [IED]

E993.5** Injury due to war operations by other improvised explosive device [IED]

E993.6 Injury due to war operations by unintentional detonation of own munitions


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ICD-9-CM New Codes Effective 1 October 2009

E993.7 Injury due to war operations by unintentional discharge of own munitions launch device

993.8 Injury due to war operations by other specified explosion

E993.9 Injury due to war operations by unspecified explosion

E994.0 Injury due to war operations by destruction of aircraft due to enemy fire or explosives

E994.1 Injury due to war operations by unintentional destruction of aircraft due to own onboard explosives

E994.2 Injury due to war operations by destruction of aircraft due to collision with other aircraft


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ICD-9-CM New Codes Effective 1 October 2009

E994.3 Injury due to war operations by destruction of aircraft due to onboard fire

E994.8 Injury due to war operations by other destruction of aircraft

E994.9 Injury due to war operations by unspecified destruction of aircraft

E995.0 Injury due to war operations by unarmed hand-to-hand combat

E995.1 Injury due to war operations, struck by blunt object

E995.2 Injury due to war operations by piercing object


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ICD-9-CM New Codes Effective 1 October 2009

E995.3 Injury due to war operations by intentional restriction of air and airway

E995.4 Injury due to war operations by unintentional drowning due to inability to surface or obtain air

E995.8 Injury due to war operations by other forms of conventional warfare

E995.9 Injury due to war operations by unspecified form of conventional warfare

E996.0 Injury due to war operations by direct blast effect of nuclear weapon

E996.1 Injury due to war operations by indirect blast effect of nuclear weapon


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ICD-9-CM New Codes Effective 1 October 2009

E996.2 Injury due to war operations by thermal radiation effect of nuclear weapon

E996.3** Injury due to war operations by nuclear radiation effects

E996.8 Injury due to war operations by other effects of nuclear weapons

E996.9 Injury due to war operations by unspecified effect of nuclear weapon

E997.3** Injury due to war operations by weapon of mass destruction [WMD], unspecified


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ICD-9-CM New Codes Effective 1 October 2009

E998.0 Injury due to war operations but occurring after cessation of hostilities by explosion of mines

E998.1 Injury due to war operations but occurring after cessation of hostilities by explosion of bombs

E998.8 Injury due to other war operations but occurring after cessation of hostilities

E998.9 Injury due to unspecified war operations but occurring after cessation of hostilities


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Summary

MHS Coding Guidance, August 2009 (reviewed and revised bi-annually or more frequently as needed)

This guidance is subject to change. More detailed information on program management is at http://www.pdhealth.mil/.

(References: MHS Coding Guidelines and PDHealth Website)


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Questions

QUESTIONS ??????


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