Inside the Military Health System and Coding
By Michelle A. Dick
Coding Edge asked military health experts to provide insight into the military health system (MHS) and coding. Here’s what they had to say:
How does the MHS work?
MHS is federally managed medicine for active duty members and their families. According to U.S. Air Force Lt. Col. (Retired) Jeanne Yoder, CPC, CPC-I, RHIA, CCS-P, military personnel earn their health care by being in the military.
The MHS is composed of two parts:
- Department of Defense (DoD) – direct care component, which are the military hospitals and clinics
- TRICARE® – the purchased-care component, which is formerly Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)
Yoder said, “Where you have large populations of beneficiaries, there tends to be direct care. An example is a hospital on an Army or a Navy base. Air Force bases usually have smaller beneficiary populations, so they tend to have more base clinics.”
When care is not available in a direct care facility, beneficiaries receive care in the civilian health care system, with payment being made through TRICARE®, according to Yoder.
What ICD-9-CM codes are used frequently on Navy ships?
Lt. Cmdr. Jori S. Brajer, deputy director for Health Care Operations and the interim department head, Health Information Management, U.S. Navy Bureau of Medicine and Surgery, said, “The types of codes used frequently on Navy ships are those which would normally be found in a primary care setting. Sailors and embarked Marines are medically screened prior to a shipboard or operational assignment. These sailors and Marines are termed worldwide deployable and exhibit no medical issues which cannot be handled on board a sea going vessel.”
Yoder said, “Ships usually have a healthy population of individuals 18-45 years of age. This population has the same health issues as most other healthy 18-45 year olds, except for the deliveries.” She added, “Common diagnoses are viral and respiratory conditions with a sprinkling of cuts, contusions, sprains, and strains.”
How is documentation handled?
“Documentation in the medical record for sailors and Marines on board ships is generally the same as it would be in our fixed medical treatment facilities and the civilian sector, said Brajer. “Currently, the documentation is generally made in the paper medical record, but the Navy is transitioning to an electronic encounter documentation system on board ships.”
As for land-based direct care facilities, Yoder said, “Documentation is in the form of an electronic health record (EHR) program called Armed Forces Health Longitudinal Technology Application (AHLTA). Most coding is template based, done by the health care provider.
Walk us through the process from when a diagnosis is made (or procedure is preformed) and documented to when a claim is billed.
Yoder said, “Once a diagnosis is made, the provider codes the encounter in AHLTA. There are nightly data feeds to the MHS central repositories with all data needed to generate a bill. This data also resides on the local servers. Approximately 5 percent of care is billed. There are three major billing programs:
- Third Party Collections generates bills for patients who have other health insurance. In general, these are the retirees and their family members who have medical insurance through their employers.
- Medical Services Account billing is for interagency billing, such as when the DoD has an agreement with the Veterans Healthcare Administration or a Department of Defense Dependents Schools (DoDDS) teacher receives care.
- Medical Affirmative Claims recovers the cost of medical treatment for DoD beneficiaries who are injured at the fault of a third party, such as when someone with automobile insurance injures a beneficiary in a motor vehicle accident.
The remaining 95 percent of care is not billed. The funding to run the facilities and pay the employees is appropriated by Congress in the DoD budget. The funds are received by the TRICARE® Management Activity (TMA) who works with the TriServices (There are only Army, Navy, and Air Force facilities; most Marine care is provided by the Navy.) to equitably distribute the funds.”
Is procedural coding the same?
According to Navy Neurosurgeon Lt. Cmdr. Stacey Wolfe, MD, at Tripler Army Medical Center, the Navy and all of the military use the same CPT® codes for coding as civilian health systems.
How is the military preparing for ICD-10?
Brajer said, “All of the services are working in concert with the TMA to prepare for ICD-10 in accordance with the federal mandate from the U.S. Department of Health & Human Services.” The Navy will be prepared to implement ICD-10 by the proposed Oct. 14, 2014 deadline.
“Navy Medicine has established a governance and leadership structure for decision-making, issue resolving, and determining the resources necessary as the Navy medicine implements ICD-10,” according to Brajer. “A project management office was deployed for ICD-10 Program Management Office (PMO), which is assessing the functional, business, and technology areas. The ICD-10 PMO drives and provides a planned structured approach to integrate, coordinate, and support ICD-10 evaluation and implementation progress, staffing and resources.” Brajer said they are “in the assessment phase, which is to identify the impact to people, processes, procedures, and technology. The ICD-10 assessment is to be followed by implementation and sustainment phases.”
“The MHS has been preparing for ICD-10 since 2004,” Yoder said. “Years ago, all computer systems using ICD-9-CM codes were identified. Examples include the blood system, aeromedical evacuation system, theatre medical systems (e.g., those used in deployed situations such as Iraq), and facility-based systems (e.g., clinic, inpatient, laboratory, radiology, immunizations, disability, pharmacy).” MHS has been reviewing all internal code edits and updating systems. “For instance,” Yoder said, “the major changes in trauma, external causes of morbidity, physical therapy, and obstetrics have all driven significant work. There are groups of individuals who have reviewed all of the policy regulations (e.g., TRICARE manuals), directives, instructions, and forms, which have all been updated for ICD-10-CM and ICD-10-PCS coding. Another group identified those who would need training. The planning is ongoing.”