Briefing: Deployment-Related Coding

1. Briefing:Deployment-Related Coding Date: 24 March 2010 Time:1110 – 1200

2. 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

3. 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)

4. 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)

5. Deployment Codes V70.5_4 Pre-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_5 Intra-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_6 Post-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.

6. Deployment Assessments V70.5_D Pre-Deployment Assessment: Documented on DD2795. V70.5_E Initial Post-Deployment Assessment: Documented on DD2796. V70.5_F Post Deployment Health Re-assessment (PDHRA): Documented on DD2900.

7. 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.

8. 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.

9. 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

10. 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)

11. 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)

12. 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

13. Initial Post-Deployment Assessment • V70.5_E Documented 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.

14. 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.

15. Post Deployment Health Reassessment (PDHRA) V70.5_F Documented 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

16. 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.

17. 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]

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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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