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Improved External Cause of Injury Coding: A Military Necessity On behalf of the Office of the Secretary of Defense LTC

Improved External Cause of Injury Coding: A Military Necessity On behalf of the Office of the Secretary of Defense LTC Steven H. Bullock, USACHPPM. DoD Health Affairs POC: Lt Col Nancy K. Fagan. Burden of Injuries and Diseases on US Army 06. ICD-9 Code Groups.

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Improved External Cause of Injury Coding: A Military Necessity On behalf of the Office of the Secretary of Defense LTC

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  1. Improved External Cause of Injury Coding: A Military NecessityOn behalf of the Office of the Secretary of DefenseLTC Steven H. Bullock, USACHPPM DoD Health Affairs POC: Lt Col Nancy K. Fagan

  2. Burden of Injuries and Diseases on US Army 06 ICD-9 Code Groups Medical Encounters = Outpatient + Inpatient Medical Encounters/ Individuals Affected *Includes all ICD-9 codes groups with less than 50,000 medical encounters Source: Medical Surveillance Monthly Report, 12(3):17, Apr07 (http://amsa.army.mil/1MSMR/2007/v14_n01.pdf#Article2)

  3. Largest Health Problem in Military • >1,200,000 injuries affecting ~900,000 Servicemembers • >25 million days of limited duty Greatest Health Threat to Military Readiness

  4. DoD Established Need for Better Coding • SECDEF: Prevent injury to improve readiness • Phase I: 28 Sep 07 C&M • E927 Overexertion & strenuous and repetitive movements or loads • Sudden traumatic • Cumulative trauma from • Repetitive impact • Repetitive motion • Prolonged static positioning • General overexertion

  5. Phase II-Oct 2008 implementation • 22 significant activity categories (PT, sports/recreation, hobbies) • Activity code status • Civilian • Work • Leisure • Student • Military • Military activity • Leisure • Expanded stress fracture diagnosis codes • Water transport improvements for military watercraft • Firearm mechanical malfunction improvements • Expansion of injuries in operations of war (battle and non-battle) • Chapter heading notes encouraging “use additional code” to describe cause

  6. Process • WHO acknowledges importance of activity for prevention • ICD-10, ICD-10-CM, ICECI, and military-only code scheme considered • Consultation with nosologists, DoD cause coding resource group (including UBU) • Parallel concepts from ICD-10 and 10-CM • Codes mutually exclusive (no redundancy) • Clear guidelines document planned

  7. Benefits of Oct 08 Implementation • Complete the redesign of EHR to capture codes • Improved surveillance now • Enables targeted resources for prevention initiatives • Provides a monitor of success of prevention strategies • Reduces costs of care • Fosters partnership with safety centers as public health agencies • Improves Force readiness • Beta-test for future system(s) • Leverages remaining lifetime of legacy system • Allows for exclusion/inclusion criteria refinement • Provides a test of coding consistency in subset population • Expandable to meet unforeseen needs • Codes remain optional for civilian use

  8. Questions

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