Provider Specialty Code Table Aug 2006 Update

Prepared by the UBO Program Support Team

DSN 761-3492 x4072Eastern Daylight Time

Tuesday, 22 Aug 06, 10:00 – 1-866-866-2244, code 7486926# Wednesday , 23 Aug 06, 7:00, 9:00, 14:00 – 1-866-866-2244, code 6087779#

Thursday, 24 Aug 06, 0900 - 1-866-866-2244, code 7486926# Friday, 25 Aug 06, 7:00, 10:00 – 1-866-866-2244, code 6087779#

Nomenclature• Provider Specialty Code. These are military unique

codes that are used to tell the provider’s specialty. They existed prior to the HIPAA taxonomy.

• HIPAA taxonomy. These are relatively new federal codes used to tell a provider’s specialty. There are two different types, individual and agency. This is about individual HIPAA taxonomies. This code says “this provider is a family practice physician.”

• National Provider Identifier (NPI). This is a code, rather like a SSAN for a provider. It is a ten digit code that is specific to the individual provider. It says “this provider is Dr. Thomas Alexander White.” There is currently no logic in CHCS that checks the HIPAA taxonomy used when a provider submits for an NPI is the same one used in CHCS. This talk is not about the NPI.

Per my SAIC Contact

• For the HIPAA Taxonomy and Provider Specialty update, the SPDS Distribution number is 1146 for the package name CHCS-SS_HPTPS_FY2006_4630-1.0.

• HIPAA Provider Taxonomy and Provider Specialty received the final PTTFN and approval to be released for worldwide deployment (18 Aug 06). It is still on schedule for worldwide deployment on 24 August 2006.

Who Might Even Care There Are Changes?

• Credentials personnel or whomever enters/updates the provider profile in CHCS

• Anyone playing the Military Health System (MHS) Prospective Payment System (PPS) Relative Value Unit (RVU) game

• Data analysts who pull data• Anyone who spends money collected

through the Third Party Collection program

Objectives

• After this brief, as of 24 August 2006 or whenever the update is loaded at your MTF, – properly assign provider specialty code (PSC)

for residents, pharmacists, dieticians and independent duty corpsmen and all the other new PSCs 90% of the time

– Have a list of provider specialty codes that you commonly use/have at your MTF that will need to be updated when the change occurs

Overview

• Why it is important to your MTF to have these correct

• Codes inactivated

• Codes added

• Nomenclatures changed

Important, but not life threatening

• I’ve been told that when the codes are inactivated, they will still report up, but just not link for billing and Prospective Payment System

• Start changes now, but probably not going to absolutely need them until 1 Oct 2008 (just not enough time to realistically get done by 1 Oct 2007)

• Look them over so you can get your residents in correctly, these would be your first priority

How To Identify Providers Needing to be Updated

• There is a possibility of a central pull posted out on the SAIC maintenance website of active providers with coded encounters within the past year with provider specialty codes needing updating.

• Otherwise, as a backup, start lining up someone at your MTF who can do an ad hoc of active providers with their provider specialty codes who have submitted SADRs in the past year.

CHCS Provider ProfileMenu Path--------- Systems Manager Menu (EVE)   Core Application Drivers Menu (XUCORE)     Data Administration Menu (DOD DA ADMIN)       Common Files and Tables Management Menu (DOD F-T BUILD MAIN MENU)         Common Files and Tables Maintenance Menu (DOD MAINTAIN F-T)           How Did I Get Here (XUSTACK)    CFS    Common Files Supplementary Menu   DEP    Department and Service File Enter/Edit   HOS    Hospital Location File Enter/Edit   HPN    Host Platform Name Enter/Edit   MCD    Medical Center Division File Enter/Edit   MTF    Medical Treatment Facility File Enter/Edit   PRO    Provider File Enter/Edit   STM    Standard Insurance Company Table Menu   UIC    UIC Management Menu   ZIP    Zip Code File Enter/Edit   ACT    Inactivate/Reactivate File Entries   SIG    SIG Select Common Files and Tables Maintenance Menu Option:

For Those Doing the Provider Specialty Code Updates

• Residents without licenses – they need supervision

• Residents with licenses – they don’t need supervision (well, not in the CHCS sense of “supervision”)

General Layout• 000-099 Medicine Physicians• 100-199 Surgeons• 200-299 Pathology/Laboratory• 300-399 Aerospace/Occupational/

Preventive/Hyperbaric/Hypobaric Medicine• 400-499 Radiology/Diagnostic Imaging• 500-599 Was consultants, now technicians• 600-699 Nurses• 700-799 Extenders (except PAs at 901)• 800-899 Dentists• 900-909 Technicians (except for PAs who started as

enlisted but are now officers)• 910-999 Clinics (not included in the MHS PPS RVU

game)

General Rules• You need to ensure you have the correct codes

for ALL your Residents – it impacts billing right NOW

• Navy requested a number of new, more detailed codes, so I suspect they want them used

• Use the code that matches the privileges awarded. For instance, if the provider is an ENT doing ENT, 130. If the provider is a Pediatric ENT doing Pediatric ENT, 135. But, if the provider is a Pediatric ENT at a tiny clinic and was awarded privileges, code it as 130.

Codes Inactivated

PROV SPEC CODE PROV SPEC DESCRIPTION002 Contract Physician (Not On Consultant List)500 SENIOR STAFF PHYSICIAN

501 ANESTHESIOLOGY CONSULTANT502 INTERNAL MEDICINE CONSULTANT503 PEDIATRIC MEDICINE CONSULTANT504 NEUROLOGY CONSULTANT505 PSYCHIATRY CONSULTANT506 DERMATOLOGY CONSULTANT507 PHYSICAL MEDICINE CONSULTANT508 SURGERY CONSULTANT509 UROLOGY CONSULTANT510 OPTHALMOLOGY CONSULTANT511 OTORHINOLARYNGOLOGY CONSULTANT512 ORTHOPEDIC SURGERY CONSULTANT513 OB/GYN CONSULTANT514 AEROSPACE MEDICINE CONSULTANT515 PREVENTIVE MEDICINE CONSULTANT516 RADIOLOGY CONSULTANT517 DENTAL CONSULTANT518 OTHER CONSULTANT700 Other Provider (Officer)711 Other Biomedical Specialist814 Dental Staff Officer

Codes Added

in the000-099

range

PROV SPEC CODE PROV SPEC DESCRIPTION

SIDR APPROVED

HIPAA PROVIDER TAXONOMY

006 Emergency Physician Resident/Intern Without License YES 390200000X007 Family Practice Physician Resident/Intern Without License YES 390200000X008 Int Med Physician / Clinical Cardiac Electrophysiology YES 207RC0001X010 Internal Medicine Resident/Intern Without License YES 390200000X033 Pediatrician / Pediatric Developmental-Behavioral YES 2080P0006X034 Pediatrician / Pediatric Medical Toxicology YES 2080T0002X035 Pediatrician / Pediatric Critical Care Medicine YES 2080P0203X036 Pediatrician / Pediatric Emergency Medicine YES 2080P0204X037 Pediatrician / Pediatric Rheumatology YES 2080P0216X039 Pediatric Resident/Intern Without License YES 390200000X062 Neurologist Resident/Intern Without License YES 390200000X076 Physicians / Psychiatry & Neurology / Addictive / Psychiatry YES 2084P0802X077 Psychiatric Resident/Intern Without License YES 390200000X082 Dermatologist Resident/Intern Without License YES 390200000X083 Physician / Dermatology / Clinical & Laboratory Immunology YES 207NI0002X084 Physician / Dermatology / Dermatological Surgery YES 207NS0135X085 Physician / Dermatology / Dermatopathology YES 207ND0900X086 Emergency Physician / Medical Toxicology YES 207PT0002X087 Emergency Physician / Pediatric Emergency Medicine YES 207PP0204X088 Emergency Physician / Sports Medicine YES 207PS0010X089 Emergency Physician / Emergency Medical Services YES 207PE0004X095 Anesthesiology Resident/Intern Without License YES 390200000X096 Physician / Physical Med & Rehab / Spinal Cord Injury Med YES 2081P0004X097 Internal Medicine Physician / Critical Care Medicine YES 207RC0200X098 Internal Medicine Physician / Interventional Cardiology YES 207RI0011X099 Internal Medicine Physician / Sport Medicine YES 207RS0010X

Codes Added in the100-199 range

112 Urology Resident/Intern Without License YES 390200000X113 Surgery Resident/Intern Without License YES 390200000X117 Plastic Surgery Resident/Intern Without License YES 390200000X122 Ophthalmology Resident/Intern Without License YES 390200000X132 Otorhinolaryngology Resident/Intern Without License YES 390200000X133 Physician / Otolaryngology / Facial Plastic Surgery YES 207YS0123X134 Physician / Otolaryngology / Otology & Neurology YES 207YX0901X135 Physician / Otolaryngology / Pediatric Otolaryngology YES 207YP0228X136 Physician / Otolaryngology / Plastic Surgery Head & Neck YES 207YX0007X143 Orthopedic Resident/Intern Without License YES 390200000X144 Physician / Orthopedic Surgery / Foot And Ankle Orthopedics YES 207XX0004X145 Physician / Orthopedic Surgery / Hand Surgery YES 207XS0106X146 Physician / Ortho Surgery / Orthopedic Surgery Of Spine YES 207XS0117X147 Physician / Orthopedic Surgery / Orthopedic Trauma YES 207XX0801X148 Physician / Orthopedic Surgery / Sports Medicine YES 207XX0005X155 OB/Gyn Resident/Intern Without License YES 390200000X156 Physician / Obstetrics & Gynecology / Critical Care Medicine YES 207VC0200X157 Physician / Obstetrics & Gynecology / Gynecology YES 207VG0400X158 Physician / Obstetrics & Gynecology / Fetal Medicine YES 207VM0101X

Codes added in the 200-499 range220 Pathology Resident/Intern Without License YES 390200000X221 Physician / Pathology / Anatomic Pathology YES 207ZP0101X222 Physician / Pathology / Anatomic Path & Clinical Path YES 207ZP0102X223 Physician / Pathology / Blood Banking & Transfusion Medicine YES 207ZB0001X224 Physician / Pathology / Chemical Pathology YES 207ZP0104X225 Physician / Pathology / Cytopathology YES 207ZC0500X226 Physician / Pathology / Dermatopathology YES 207ZD0900X227 Physician / Pathology / Hematology YES 207ZH0000X228 Physician / Pathology / Immunopathology YES 207ZI0100X303 Aerospace Medicine Resident/Intern Without License YES 390200000X324 Physician / Preventive Medicine / Medical Toxicology YES 2083T0002X325 Physician / Prevent Med / Public Hlth & General Prevent Med YES 2083P0901X408 Radiology Resident/Intern Without License YES 390200000X410 Physician / Radiology / Pediatric Radiology YES 2085P0229X411 Physician / Radiology / Radiation Oncology YES 2085R0001X

Codes added in the 500-599 range

520 Corpsman, Independent Duty YES 1710I1002X521 TECHNICIAN, INDEPENDENT DUTY MEDICAL YES 1710I1003X

530 Pastoral Counselor YES 101YP1600X580 Student, Medical YES 390200000X581 Student, Dental YES 390200000X

Codes added in the 700-899 range

750 Pharmacist, General Practice YES 1835G0000X830 Oral Surgery Resident Without License YES 390200000X831 Periodontic Resident Without License YES 390200000X832 Prosthodontic Resident Without License YES 390200000X833 Orthodontic Resident Without License YES 390200000X834 Oral Pathology Resident Without License YES 390200000X835 Endodontic Resident Without License YES 390200000X836 Pedodontic Resident Without License YES 390200000X

Codes ChangedPROV SPEC CODE PROV SPEC DESCRIPTION

SIDR APPROVED

HIPAA PROVIDER TAXONOMY

003 Family Practice Physician Resident/Intern With License YES 208D00000X005 Emergency Physician Resident/Intern With License YES 208D00000X028 Internal Medicine Resident/Intern With License YES 208D00000X046 NEONATALOGIST-PERINATOLOGIST YES 2080N0001X

052 Pediatric Resident/Intern With License YES 208D00000X061 Neurologist Resident/Intern With License YES 208D00000X081 Dermatologist Resident/Intern With License YES 208D00000X093 Anesthesiology Resident/Intern With License YES 208D00000X108 Surgery Resident/Intern with License YES 208D00000X111 Urology Resident/Intern With License YES 208D00000X115 Plastic Surgery Resident/Intern With License YES 208D00000X121 Ophthalmology Resident/Intern With License YES 208D00000X131 Otorhinolaryngology Resident/Intern With License YES 208D00000X142 Orthopedic Resident/Intern With License YES 208D00000X154 OB/Gyn Resident/Intern With License YES 208D00000X207 Pathology Resident/Intern With License YES 208D00000X301 Aerospace Medicine Resident/Intern With License YES 208D00000X406 Radiology Resident/Intern With License YES 208D00000X

Codes Changed

701 Aerospace Physiologist YES 1744R1102X704 Dietician-Nutritionist YES 133V00000X713 Chiropractor YES 111N00000X801 Oral Surgery Resident With License YES 122300000X803 Periodontic Resident With License YES 122300000X805 Prosthodontic Resident With License YES 122300000X807 Orthodontic Resident With License YES 122300000X809 Oral Pathology Resident With License YES 122300000X811 Endodontic Resident With License YES 122300000X

816 Pedodontic Resident With License YES 122300000X

One Strange Set

PROV SPEC CODE PROV SPEC DESCRIPTION

SIDR APPROVED

HIPAA PROVIDER TAXONOMY

150Obstetrician & Gynecologist (OB/GYN) YES 207V00000X General OB/GYN

151 Endocrinologist, Ob/Gyn YES 207VE0102X Reproductive Endocrinology152 Oncologist, OB/Gyn YES 207VX0201X Gynecologic Oncology

153 Pathologist, OB/Gyn YES 207ZP0102XAnatomic Pathology & Clinical Pathology

154OB/Gyn Resident/Intern With License YES 208D00000X GMO

155OB/Gyn Resident/Intern Without License YES 390200000X Student

156

Physician / Obstetrics & Gynecology / Critical Care Medicine YES 207VC0200X

OB/GYN Critical Care Medicine

157Physician / Obstetrics & Gynecology / Gynecology YES 207VG0400X Gynecology

158Physician / Obstetrics & Gynecology / Fetal Medicine YES 207VM0101X

OB/GYN Maternal & Fetal Medicine

Something Else That Needs Looking Into

702 Clinical Psychologist YES 103TC0700X703 Psychology Social Worker YES 104100000X

Quiz (to see if you were listening)

What is new about assigning residents?

What is the new code for pharmacists?

Why do you need to update dieticians?

What is the new IDC code (only for Navy personnel)?

What you really need to remember from this

• Contact your System Administrator and ask for the updated HIPAA taxonomy table and the updated Provider Specialty Code table and find out when it will run at your MTF

• Fix your residents, pharmacists, dieticians, aerospace physiologists (and all the inactivated codes if you want credit for your work)

• For Navy, split out the updated specialties• Now you have a specific place for medical

students and pastoral counselors