2010 UBO/UBU Conference Health Budgets & Financial Policy 1 Briefing: Above and Beyond ICD-9- CM –...

2010 UBO/UBU Conference

Health Budgets & Financial Policy

1

Briefing: Above and Beyond ICD-9-CM – The DoD Extender Codes

Date: 24 March 2010

Time: 1610–1700

2010 UBO/UBU ConferenceTurning Knowledge Into Action Objectives

Find out if anyone in the class is using the data provided by some of the DoD extenders (and realize that some of these really do help the patients)

Be aware of the variety of DoD extenders (if you don’t even know it exists, how do you know to look for it)

Be able to give an example of when the creation, marketing and extra work to collect would be worth the data collected

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2010 UBO/UBU ConferenceTurning Knowledge Into Action How the Class Will Work

On the desk is a quiz – fill it out A segment of DoD Extenders will be introduced I’ll bore you with details If you have an applicable joke, raise your hand

– Puns and dry humor are appreciated Anyone who may fall asleep, put your head down so you

won’t fall over when you do fall asleep The next segment of DoD Extenders will be introduced At the end we will awaken the sleepers

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2010 UBO/UBU ConferenceTurning Knowledge Into Action DoD Extenders

Why How Who uses Who collects DoD Extender Management – ask requestor annually

– 1. There could be a better way to collect (e.g., CPT category II codes, ICD-9-CM code request)

– 2. Are the data are still needed– 3. Are the data are providing the information that was

anticipated– 4. Is the cost to collect worth the resources to collect

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Viral Hepatitis

070xxx Possible extenders:

– 0 - Lab test confirmed – 1 - Lab test not reported or negative– 2 - Lab test not performed

Are not used for the other than viral (found in the liver part of the ICD-9-CM around 571) hepatitis

Will not be needed when the Ancillary SADR laboratory feed includes results – In the next couple of years, before ICD-10, hopefully

HEDIS measures are only for Hepatitis C

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Viral Hepatitis

Show of hands – do you know what organization needs/uses these data?

Let’s run the questions– 1. There could be a better way to collect (e.g., CPT

category II codes, ICD-9-CM code request)– 2. Are the data are still needed– 3. Are the data are providing the information that was


What about the CPT category II hepatitis codes? Jokes? Stories?

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2010 UBO/UBU ConferenceTurning Knowledge Into Action

Kawasaki vs. Other Acute Febrile Mucocutaneous Lymph Node Syndrome

446.1 Possible extenders:

– 0 - Kawasaki – rare, usually in children 2-5 years old, usually male, inflammation of blood vessels, usually initial treatment is in the hospital

– 9 - Other acute febrile mucocutaneous lymph node syndrome

In FY09 SIDR (Standard Inpatient Data Record), with a 446.1x diagnosis in 1st, 2nd, 3rd, 4th, or 5th diagnosis - there were – 39 total 446.1x dispositions – 38 were 446.1 0– 1 was 446.1 9 (a 4 year old male with a 3-day length

of stay)

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Kawasaki vs. Other Acute Febrile Mucocutaneous Lymph Node Syndrome

Show of hands – do you know what organization needs/uses these data?– 1. There could be a better way to collect (e.g., CPT

category II codes, ICD-9-CM code request)– 2. Are the data are still needed– 3. Are the data are providing the information that was


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2010 UBO/UBU ConferenceTurning Knowledge Into Action Asthma

493xx Possible extenders:

– 0 – Unspecified; 1 – Mild; 2 – Mild Persistent; 3 – Moderate; 4 - Severe

Needed IN THE PAST for HEDIS measures– (Healthcare Effectiveness Data and Information Set)

Even though there is space, these are not in ICD-10-CM– Could it be that the CPT category II suffice?

HEDIS concerned with “Appropriate Medications for People with Asthma” – Looking for persistent asthma patients with

appropriate medications prescribed

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327,000 outpatient encounters in FY09 for asthma 1005F,1038F,1039F,4015F (the CPT asthma Category

II) only coded 1,291 times in FY09; but as you can see, 327,916 asthma codes…

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1st dx 2nd 3rd 4th Total0 NOS 39,222 23,679 9,152 4,285 76,3381 mild 49,017 37,442 13,830 5,449 105,7382 mild persist 54,489 24,871 8,538 3,100 90,9983 moderate 32,538 9,968 2,874 1,182 46,5624 severe 7,223 1,164 440 141 8,968total: 327,916 182,489 97,124 34,834 14,157 328,604


1005F – Asthma symptoms evaluated (includes physician documentation of numeric frequency of symptoms or patient completion of an asthma assessment tool/ survey/ questionnaire)– Coded 1,147 times in FY09

1038F – Persistent asthma (mild, moderate or severe)– Coded 49 times in FY09 (but the persistent modifier

was used 90,000 times) 1039F – Intermittent asthma

– Coded 33 times in FY09 4015F – Persistent asthma, preferred long term control

medication or an acceptable alternative treatment, prescribed– Coded 106 times in FY09

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Reactive Airway Disease


– 0 – Other diseases of lung, NEC– 1 – Reactive airway disease

Needed to separate from asthma as pilots are grounded for asthma, but not reactive airway disease

FY09 SADR 518.89 1st dx 2nd dx 3rd dx 4th dx total0 - Other Lung NEC 3,785 2,209 1,101 672 7,7671 - Reactive Airway 1,439 1,104 274 71 2,888total 10,655 5,224 3,313 1,375 743 10,655

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Elective Termination of Pregnancy

635 Possible extenders:

– 0 - Elective– 1 - Therapeutic– 2 - Elective, terminated elsewhere– 9 - Unspecified

Of the 9 inpatients with 635x in FY09, 7 were “elective, terminated elsewhere”

ICD-10-CM does not collect the data in the extenders Was told a report needed to be sent to Congress – is this

still the case?

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Attempted Termination of Pregnancy

638 Possible extenders:

– 0 - Elective– 1 - Therapeutic– 9 - Unspecified

ICD-10-CM does not separate elective and therapeutic FY09 outpatient encounters – 8, and all were elective

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Stress Fracture/Reaction

733 Multiple configurations of extenders:

– Fracture vs. Reaction– Tibia vs. Fibula– Pelvis, inferior pubic rami, superior pubic rami, pubic

rami In FY09, of the 166 admissions for stress

fracture/reaction, 3 are for reactions ICD-10-CM does not collect fracture vs. reaction Why do we collect this? Who uses it? How?

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Persian Gulf War


– 1 - Persian Gulf War Vet– 2 - PGW Family Member– 8 - Not PGW Syndrome, Other Unknown or

Unspecified Cause of Morbidity or Mortality Persian Gulf War (2 Aug 1990 – 28 Feb 1991 ~ 20 years

ago)

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799.9 1 Persian Gulf War Vet 799.9 2 PGW Family Member 799.8 8 Not PGW Syndrome, Other Unknown or Unspecified Cause

of Morbidity or Mortality

Encounters Diagnosis 1 Diagnosis 2 Diagnosis 3 Diagnosis 4 Gender Age1 7999 1 7999 2 7999 8 V6110 M 241 7999 1 7999 2 7999 8 V629 F 341 7999 1 7999 2 7999 8 V629 M 381 7999 1 7999 2 7999 8 F 421 7999 1 7999 2 7999 8 M 201 7999 1 7999 2 7999 8 M 222 7999 1 7999 2 7999 8 M 231 7999 1 7999 2 7999 8 M 271 7999 1 7999 2 7999 8 M 331 7999 1 7999 2 7999 8 M 362 7999 1 7999 2 7999 8 M 391 7999 1 7999 2 7999 8 M 56

14 Sum:

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Persian Gulf War– 3,136 of the 3,824 FY09 SADR with 799.9 1 in the

2nd position are 0-35 years old– 2,243 of the 3,400 FY09 SADR with 799.9 1 in the 3rd

position are 0-35 years old– 7,925 of the 9,882 FY09 SADR coded with 799.9 1

Persian Gulf War Vet are for individuals 0-35 years old (21 are younger than 1 year)

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Not Persian Gulf War

799.9 8 Other Unknown and Unspecified Causes of Morbidity and Mortality, Not Persian Gulf War – 40,711 in 1st diagnosis in FY09 SADR– 24,759 in 2nd diagnosis– 13,557 in 3rd diagnosis– 4,455 in 4th diagnosis– Total of 83,000 of 101,000 are coded with “Not

Persian Gulf War” Persian Gulf War Syndrome is not a diagnosis in ICD-

10-CM

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Infection and Inflammatory Reaction Due to Vascular Device, Implant, and Graft

996.62 Infection and inflammatory reaction due to vascular device, implant, and graft

Possible extenders:– 0 NOS– 1 Jugular vein– 2 Subclavian vein– 3 Femoral vein– 4 Other specified vein– 5 Vein NOS

2,060 discharges in FY09 SIDR with 996.62 in 1st. 2nd, 3rd, 4th, or 5th diagnosis

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86% of the 2,060 FY09 SIDR with 996.62 in 1st, 2nd, 3rd, 4th, 5th diagnosis – no extender

ICD-10-CM does not have specificity of complications of vascular devices, implants, and grafts (jugular, subclavian, femoral veins)

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996.62 no 0 1 2 3 4 51st dx 776 72 14 14 13 13 142nd dx 338 17 3 3 3 10 33rd dx 296 20 3 4 3 4 44th dx 198 21 2 2 1 4 25th dx 170 14 3 1 1 3 3



Requested to determine if there was a variation on which vein to use for the vascular device

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Personal History of TBI, GWOT or Not

V15.59 Other Personal History Presenting Hazards to Health, Other Possible extenders:

– 0 – root code– 1 – Global War on Terrorism (GWOT), unknown– 2 – GWOT, TBI mild– 3 – GWOT, TBI moderate– 4 – GWOT, TBI severe– 5 – GWOT, penetrating intracranial wound– 6 – Not GWOT, unknown– 7 – Not GWOT, mild– 8 – Not GWOT, moderate– 9 – Not GWOT, severe– A – Not GWOT, penetrating– B – Unknown if GWOT, unknown– C – Unknown if GWOT, mild– D – Unknown if GWOT, moderate– E – Unknown if GWOT, severe– F – Unknown if GWOT, penetrating

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Personal History of TBI, GWOT or Not

FY09 SIDR, 380 patients with V15.59 x in diagnoses 1, 2, 3, 4, 5 (unconfirmed are not included)

Short Name 1st dx 2nd dx 3rd dx 4th dx 5th dxV15.59 0 Other Personal History 0 25 22 18 14V15.59 1 TBI GWOT, unknown 0 25 26 30 25V15.59 2 TBI GWOT, mild 0 6 11 22 15V15.59 3 TBI, GWOT, moderate 0 2 0 5 2V15.59 4 TBI, GWOT, severe 0 1 2 0 1V15.59 5 TBI, GWOT, penetrating 0 0 1 1 2V15.59 6 TBI, Not GWOT, unknown 0 20 22 13 15V15.59 7 TBI, Not GWOT, mild 0 2 5 2 0V15.59 8 TBI, Not GWOT, moderate 0 1 0 2 0V15.59 9 TBI, Not GWOT, severe 0 1 0 2 0V15.59 A TBI, Not GWOT, penetrating 0 2 3 1 2V15.59 B TBI, Unknown if GWOT, unknown 0 1 3 12 6V15.59 C TBI, Unknown if GWOT, mild 0 0 0 1 1V15.59 D TBI, Unknown if GWOT, moderate 0 0 0 1 0V15.59 E TBI, Unknown GWOT, severe 0 0 0 1 0V15.59 F TBI, Unknown if GWOT, penetrating 0 0 0 2 0

86 95 113 83

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Hearing Conservation Profile

V41.2 Possible modifiers:

– 0 Other and unspecified problems with hearing– 1 Profile H-1– 2 Profile H-2– 3 Profile H-3– 4 Profile H-4

14,326 FY09 SADR with hearing conservation profiles

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Hearing Conservation Profile

Profiles are not a civilian sector issue, the is no similar code in ICD-9-CM

1st 2nd 3rd 4thV41.2 0 OTHER AND UNSPECIFIED

PROBLEMS WITH HEARING 815 212 124 90V41.2 1 HEARING CONSERVATION,

PROFILE H-1 1755 4266 3217 853V41.2 2 HEARING CONSERVATION,



PROFILE H-4 1 1 2 1

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Acquired Absence of Breast

V45.71 Possible extenders:

– 1 Left– 2 Right– 3 Bilateral

Need for HEDIS – for identifying patients needing mammograms

1st 2nd 3rd 4thV45.71 1 ACQUIRED ABSENCE OF LEFT BREAST

AND NIPPLE 177 505 377 296V45.71 2 ACQUIRED ABSENCE OF RIGHT BREAST

AND NIPPLE 150 441 381 203V45.71 3 ACQUIRED ABSENCE OF BILATERAL

BREASTS 370 696 405 275FY09 SADR total 4,274 697 1642 1163 774

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Acquired Absence of Genital Organs

V45.77 Possible extenders – 0-9, A and B ICD-10-CM does not have the entire list (e.g., uterus,

uterus with cervix, ovaries, prostate) Needed for HEDIS? HEDIS CPT measures

– 3014F Screening mammography results documented and reviewed

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Acquired Absence of Genital Organs

V45.77 12,456 total 1st dx 2nd dx 3rd dx 4th dxV45.77 0 Acquired absence of uterus 47 230 185 81 543

V45.77 1 Acquired absence of uterus and cervix

157 722 466 184 1529

V45.77 2 Acquired absence of left ovary

25 136 199 89 449

V45.77 3 Acquired absence, right ovary 25 139 130 84 378

V45.77 4 Acquired absence, bilateral ovaries

315 854 1193 609 2971

V45.77 5 Acquired absence, left testis 31 90 73 17 211

V45.77 6 Acquired absence, right testis 25 76 41 17 159

V45.77 7 Acquired absence, bilateral testes

9 30 16 7 62

V45.77 8 Acquired absence, genital organ, NOS

338 1360 741 295 2734

V45.77 9 Acquired absence of prostate 3 464 338 112 917

V45.77 A Acquired absence multi-organs, female

446 1106 780 305 2637

V45.77 B Acquired absence multi-organs, male

3 4 3 2 12

12,456 total some multiples 12602

FY09 SADRs

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Other Health Impact/Case Management

V49.89 Possible extenders: 0 – NOS, 1 – Not Case Mngt,

2 – CM start, 3 – CM continue, 4 – CM end, 5 – CM other

Needed to track case management Not in ICD-10-CM

FY 09 SADRs - 399,386 encounters 1st dx 2nd dx 3rd dx 4th dxV49.89 0 Other Specified Conditions Influencing Health

Status Other14,898 523 68 36 15,525

V49.89 1 Other Specified Condition, Not Case Management

4,399 262 85 38 4,784

V49.89 2 Case Management Start 29,603 1,854 136 47 31,640V49.89 3 Case Management Continue 275,716 17,212 1,204 217 294,349V49.89 4 Case Management End 23,754 1,263 60 23 25,100V49.89 9 Case Management, Other And Unspecified 27,001 926 57 15 27,999

some multiples 399,397

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Alcohol and Substance Abuse Education

V65.42 Possible extenders:

– 0 – Alcohol education– 1 – Substance abuse counseling

ICD-10-CM has separate codes Mental Health community wanted to know if alcohol or

substance abuse education

FY09 SADR 110,824 1st dx 2nd dx 3rd dx 4th dxV65.42 0 Alcohol education 22,291 11,498 12,517 4,880 51,186V65.42 1 Substance abuse

counseling32,523 18,629 9,016 4,672 64,840

many multiples 116,026

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Counseling

V65.49 Possible extenders: 0-9, A, B ICD-10-CM has separate codes Used 891,912 times in SADRs in FY09

– 264,790 by nurses (provider specialty code 600) Mostly with chronic conditions, e.g., diabetes

– 88,553 by technicians (PSC 900) Mostly with preventive health assessments (V70.5x)

– 76,521 by PAs (PSC 901) Mostly PHAs (25,471) and well women

– Common 1st listed dx 249-250 = 7,247; 305.1 = 12,351; V03-V07.9 = 15,278 V20.2 = 13,460; V22-V23.9 = 36,291; V70.5 0-H = 111,110

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Counseling V65.49 x

ExtendersQty of encounters

Diagnosis with extender

1st listed code on SADR with V65.49 x FY09

196 V6549 3 CALCIUM REPLACEMENT EDUCATION227 V6549 2 HORMONE REPLACEMENT EDUCATION747 V6549 B SUICIDE EDUCATION2,839 V6549 7 OCCUPATIONAL STRESS EDUCATION4,284 V6549 6 OCCUPATIONAL EXPOSE EDUCATION4,807 V6549 A STRESS EDUCATION5,921 V6549 0 CANCER EDUCATION13,500 V6549 4 TOBACCO CESSATION COUNSELING21,628 V6549 8 MENTAL HEALTH EDUCATION22,513 V6549 5 TRAVEL MEDICINE EDUCATION43,719 V6549 1 MEDICATION EDUCATION291,834 V6549 9 OTHER SPECIFIED COUNSELING412,215

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Counseling V65.49 x

Many multiple types of counseling on single encounter Most commonly on Military Related Physicals/Preventive Health

Assessments

Qty Code 1st listed code on SADR with V65.49 x FY0951 V705 C PHYSICAL READINESS TEST (PRT)190 V705 5 DURING DEPLOYMENT EXAMINATION406 V705 B PHYS EXAM,ABBREVTD SEPARATION408 V705 H OTHER EXAM, DEFINED POPULATION757 V705 G GWOT/WOUNDED WAR EXAM1,141 V705 7 FITNESS FOR DUTY EXAMINATION1,472 V705 A HEALTH EX,DEFND SUBPOPULATION1,649 V705 0 ARMED FORCES MEDICAL EXAM1,994 V705 8 ACCESSION EXAMINATION2,069 V705 F POST-DEPLOY EXAM ON DD 29002,425 V705 1 AVIATION EXAMINATION3,179 V705 9 TERMINATION EXAMINATION6,230 V705 4 PRE-DEPLOYMENT EXAMINATION8,579 V705 E INITIAL POST-DEPLOY ON DD279610,504 V705 D PRE-DEPLOY DOCUMENT ON DD279514,499 V705 6 POST-DEPLOYMENT EXAMINATION23,355 V705 3 OCCUPATIONAL EXAMINATION32,202 V705 2 PERIODIC PREVENT EXAMINATION111,110

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Health Exams of DefinedSubpopulation V70.5

V70.5 x Possible extenders: 0-9 and A-H 592,916 encounters with V70.5 x in at least one of the 4

diagnosis positions 478,111 encounters with V70.5 x in first listed diagnosis

position (so for 114,805 V70.5 is NOT the first listed)

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2010 UBO/UBU ConferenceTurning Knowledge Into Action V70.5 x First Listed, Not First Listed

If these are health assessments, they should be first listed except…

Code Description only first listed

could be other than first listed

# first listed

# other than first listed

V70.5 0 Initial general accession exam x 64,963 780V70.5 1 Initial qualifying and any recurring aviation exam x 28,946 302V70.5 2 PHA or a complete military physical exam which is not an accession,

occupational, separation, termination or retirement examx 157,522 3,862

V70.5 3 Both initial qualifying and recurring exams because the individual works in a specific occupation

x 31,266 441

V70.5 4 Encounter related to a projected deployment. x 24,018 6,298V70.5 5 Deployment-related encounter performed while individual (active duty [AD],

contractor, etc.) is deployedx 1,956 3,928

V70.5 6 Specifically performed because an individual was deployed x 63,774 52,576V70.5 7 Primary reason for being seen is to determine the ability to perform their x 31,141 3,371V70.5 8 A special medical examination on individuals being considered for special

programs prior to Service entryx 11,730 416

V70.5 9 Examination performed at the end of employment x 24,714 539V70.5 A Performed on a person in a specified group (refugees, prisoners, preschool

children, etc.) other than exams identified abovex 10,721 342

V70.5 B Partial examination is done within a defined period after a complete examination as an update

x 4,258 132

V70.5 C Evaluation of service member by a provider who is privileged to determine participation in Physical Fitness Assessment program (PFA) or physical conditioning

x 2,662 140

V70.5 D Pre-Deployment Assessment: Documented on DD2795 x 3,282 34V70.5 E Initial Post-Deployment Assessment: Documented on DD2796 x 5,495 32V70.5 F Post Deployment Health Reassessment (PDHRA): Documented on x 6,513 199V70.5 G Global War on Terrorism (GWOT)/Wounded Warriors (WW). To be used if

the individual is formally designated a Wounded Warriorx 1,274 3,071

V70.5 H Other Exam Defined Population x 3,876 517478,111 76,980

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Observation Following Accident –Head Injury

V71.4 Observation Following Other Accident– 0 – head injury ruled out– 9 – injury (not head) ruled out

2,531 encounters– First dx/Second / Third / Fourth

1,362 / 112 / 23 / 11 V71.4 0 head injury r/o 909 / 77 / 23 / 14 V71.4 9 other injury r/o

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Observation Following Other Inflicted Injury

V71.6 x – 0 – head injury ruled out– 9 – injury (other than head) ruled out– Coded 171 times in FY09 SADR

first listed 2nd dx 3rd dx 4th dxV71.6 0 74 10 7 1 92V71.6 9 71 7 1 79

145 17 8

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Exam for Hearing Exam Following Failed Hearing Screening

V72.11 coded 20,480 times in FY2009 on SADRs Possible extenders:

– 0 – root code– 1 – otoscopic exam done– 2 – otoscopic exam not done

Qty FY09 PSC Provider description78 321 Occupational Medicine Physician91 000 General Medical Officer

125 604 Primary Care Nurse Practitioner - Qualified128 001 Family Practice Physician155 901 Physician Assistant181 040 Pediatrician210 302 Aerospace Med Flight Surgeon/Family Practice Physician376 300 Aerospace Medicine Physician473 600 Nurse, General Duty

4,989 709 Audiologist13,485 900 Corpsman/Technician

Total20,480

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Exam for Hearing Exam Following Failed Hearing Screening

Most of them coded are with an otoscopic exam

1st dx 2nd dx 3rd dx 4th dx totalV72.11 0 3563 2792 1198 539 8092V72.11 1 5867 4492 388 132 10879V72.11 2 722 723 60 4 1509total 10152 8007 1646 675

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Other Exam of Ears and Hearing

V72.19 Possible extenders

– 0 – root code– 1 – otoscopic exam done– 2 – otoscopic exam not done

Qty PSC Description1,655 001 Family Practice Physician1,713 000 General Medical Officer2,874 040 Pediatrician4,055 300 Aerospace Medicine Physician7,069 604 Primary Care Nurse Practitioner - Qualified7,896 321 Occupational Medicine Physician

10,592 901 Physician Assistant15,573 521 Technician, Independent Duty Medical44,394 600 Nurse, General Duty63,358 709 Audiologist

610,178 900 Corpsman/Technician773,622 total

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Other Exam of Ears and Hearing

V72.19 0 – Other exam of ears and hearing V72.19 1 – Exam of ears/hearing, otoscopic exam done V72.19 2 – Exam of ears/hearing, otoscopic exam not done Basically, if no otoscopic exam done, just using the root

code

1st dx 2nd dx 3rd dx 4th dx totalV72.11 0 3563 2792 1198 539 8092V72.11 1 5867 4492 388 132 10879V72.11 2 722 723 60 4 1509total 10152 8007 1646 675

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Special Screening, Neurologic

V80.0 (is now V80.09 as V80.01 Screening for Traumatic Brain Injury was added in FY2010)

Possible extenders:– 0 – No diabetic foot check– 1 – Diabetic foot check

PSC Provider V80.0 0 V80.0 1 Totalw/o foot check foot check

001 Family Practice 921 102 1023011 Internist 43 48 91060 Neurologist 96 2 98604 Primary Care NP 670 791 1461750 Pharmacist 2 532 534900 Technician 216 1 217901 Physician Assistant 1605 3 1,608

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Special Screening, Neurologic

V80.0 extender is not necessary as the CPT 2028F has been around for years.

2028F Foot examination performed (includes examination through visual inspection, sensory exam with monofilament, and pulse exam – report when any of the 3 components are completed)

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Special Screening, Other Eye Condition

V80.2 Special screening, other eye condition (not to include glaucoma)

Possible extenders:– 0 not including diabetic eye check– 1 including diabetic eye check

Coded 37,733 times in FY09 SADR– Including 2,067 times by nurses and 2,957 times by

technicians– V80.2 0 coded 9,372 times– V80.2 1 coded 28,362 times

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2010 UBO/UBU ConferenceTurning Knowledge Into Action Special Screening, Other Eye Condition

V80.2 Special screening, other eye condition (not to include glaucoma)

Not necessary to have extender – have CPT codes– 2022F Dilated retinal eye exam with interpretation by

an ophthalmologist or optometrist documented and reviewed

– 2024F 7 standard field stereoscopic photos with interpretation by an ophthalmologist or optometrist documented and reviewed

– 2026F Eye imaging validated to match diagnosis from 7 standard field stereoscopic photos results documented and reviewed

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Summary

We probably need to “clean up” the extenders We need an annual review of all extenders to ensure

they are all needed Before asking for an extender, see if there is a better

way Traumatic Brain Injury will continue to be stressed as the

incidence is increasing and they involve long term care


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Quiz

Why isn’t the DoD making more use of the CPT category II codes?


49

Q&A

Questions?

2010 UBO/UBU Conference Health Budgets & Financial Policy 1 Briefing: Above and Beyond ICD-9- CM –...

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