Capture Active Duty Diagnoses with DoD Unique Codes
These “unique” codes allow more specific diagnosis reporting and statistics.
The Defense Health Agency (DHA), which supports the delivery of health services to Military Health System beneficiaries, occasionally requests the National Center for Health Statistics to create new codes. Sometimes when the codes are needed for data collection unique to the Department of Defense (DoD), the DoD creates temporary “DoD unique codes.” The addition of DoD unique codes increases specificity of health services.
There are four categories of DoD unique codes.
1. Traumatic Brain Injury Codes
To garner more detail regarding traumatic brain injuries (TBI), the DHA calls on more detailed TBI, history of TBI, and screening for TBI codes.
DOD0101 Personal history of traumatic brain injury (TBI), highest level of severity unknown
DOD0102 Personal history of traumatic brain injury (TBI), highest level of severity mild (Glasgow coma scale 13-15), LOC<1hr, post trauma amnesia <24hr
DOD0103 Personal history of traumatic brain injury (TBI), highest level of severity moderate (Glasgow coma scale 9-12), LOC 1-24 hrs, post trauma amnesia 2-7 days
DOD0104 Personal history of traumatic brain injury (TBI), highest level of severity severe (Glasgow coma scale 3-8), LOC >24hrs, post trauma amnesia >7 days
DOD0105 Personal history of traumatic brain injury (TBI), penetrating intracranial wound (no level of severity assigned)
DOD0121 Screening for traumatic brain injury (TBI), negative findings
DOD0122 Screening for traumatic brain injury (TBI), positive findings
DOD0123 Screening for traumatic brain injury (TBI), declined by patient
DOD0124 Screening for traumatic brain injury (TBI), not performed due to existing diagnosis of TBI
DOD0125 Screening for traumatic brain injury (TBI), not performed due to reason other than existing TBI diagnosis
2. Occupational Health Codes
A major focus of healthcare in the military is ensuring active duty personnel are able to perform the mission and are ready to deploy.
The DHA collects initial baseline physical status when a member enters the military. It also frequently collects baseline information — such as mental processing (to compare after a TBI) and hearing (to identify threshold shifts), as well as the physical ability level — before a member starts a new job, during the job, and upon changing jobs. The DHA also performs evaluations and collects the physical and mental status of a member upon separation (leaves the military) or retirement.
When there is a diagnosis that keeps someone from doing a job, the DoD performs evaluations specific to that diagnosis and job.
For every active-duty member pregnancy, a fetal protection exam is performed that includes reviewing the member’s job, the chemicals associated with the job, work hours, pounds lifted, etc. This is to ensure active duty and other employees are as safe on the job as possible.
DOD0211 Assessment, pre-deployment, documented on DD2795
DOD0212 Assessment, post-deployment, documented on DD2796
DOD0213 Assessment, post deployment, documented on DD2900 (PDHRA)
DOD0214 Exam, formal occupational health program including hearing conservation program, establish baseline prior to occupational workplace exposure
DOD0215 Exam, formal occupational health program including hearing conservation program, periodic for continued surveillance for occupational workplace exposure
DOD0216 Exam, formal occupational health program including hearing conservation program, due to termination of occupational workplace exposure
DOD0217 Exam, occupational, aviation, long
DOD0218 Exam, occupational, aviation, short
DOD0219 Evaluation, occupational, disability evaluation system program
DOD0220 Evaluation, occupational, medical evaluation board
DOD0221 Evaluation, occupational, physical evaluation board
DOD0222 Exam, occupational, retirement from military uniformed service, long
DOD0223 Exam, occupational, retirement from military uniformed service, short
DOD0224 Exam/assessment, occupational, for individual in personal reliability program/surety (chemical/biological/nuclear) program
DOD0225 Exam/assessment, occupational, service member periodic health assessment (PHA)
DOD0226 Exam/assessment, occupational, service member participation in physical fitness training/testing
DOD0227 Exam/assessment, occupational, fetal protection program
DOD0228 Exam/assessment, occupational, temporary disability retired list program
DOD0229 Exam for the DOD medical exam review board (e.g., for entry into a uniformed services academy)
3. Administrative Codes
Case management is very important. The DHA collects data on which individuals are receiving various intensities of case management, by case manager. This data is used to better manage case managers. Nurses and social workers use the codes to record the time and number of case management services provided.
DOD0301 Case management start
DOD0302 Case management continue
DOD0303 Case management end
Just like other diagnoses and factors influencing health, these unique codes improve the ability to provide the right care, at the right level, at the right time. These codes are used in data collection systems in the same manner as diagnosis codes. Edits are in place so these codes are not included in HIPAA standard transactions, such as bills.
4. Inpatient Processing Codes
The last set of DoD unique codes appear in the diagnosis field for inpatients discharged, but the records are not yet coded. The codes let DHA know if the admission was a newborn, due to an injury, or any other type of admission.
Overseas Care Adds Another Element
TRICARE® uses standard HIPAA electronic transactions for most of its claims. The largest component of non-standard claims is for overseas care. These claims are submitted to managed care support contractors for processing because the claims are for care outside the United States. The managed care support contractors process all the claims, and submit data to the TRICARE® central repositories with code sets unique to TRICARE®.
For instance, before the HIPAA Healthcare Provider Taxonomy, most insurers had their own code sets to describe the specialty of the provider. Managed care support contractors use the guidance in the TRICARE® manuals to provide the data required by TRICARE® for internal use.
Setting the Record Straight
There’s a common misconception that the Veterans Health Administration (VHA) is associated with DoD healthcare. When active duty members have a medical condition that begins or worsens during their service, in some instances, those members may be eligible for VHA healthcare to manage that specific problem. The VHA’s relationship to DoD healthcare is rather like the workers’ compensation program is to civilian employees.
Direct Care vs. TRICARE®
The Military Health System has two major components:
1. “Direct care” are the services provided in a military healthcare facility.
TRICARE® is the purchased care component. TRICARE® is used mostly by military healthcare beneficiaries who do not live in the area of a military healthcare facility, and for healthcare services not offered at the military healthcare facility. DoD unique codes are only used in direct care, but there are other DHA unique procedure-type codes used in both components.
Don’t Confuse “Unique” with “Extender” Codes
With ICD-9-CM, the DoD used “DoD extender codes.” These all had an ICD-9-CM code as a “root” and an alphanumeric character was added to the end of the ICD-9-CM code. The extender collapsed back down into the root code. For instance, there were many V70.5 Health examination of defined subpopulations extenders, for all the different occupational physicals.
The DoD extender codes went extinct with the change to ICD-10-CM. With ICD-10-CM implementation, there are “DoD unique codes,” which are a way to collect more specific information, but can easily be changed, unlike standard NCHS codes.
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