Appendix A. External Code Sources

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A.1 External Code Sources

Appendix A is a listing of all external code sources referenced in this implementation guide.

  • Where an external code source is referenced, the implementer is required to use only the codes from that list.

  • Codes must be reported as listed in the code source (e.g. with leading zeroes).

  • Implementers must follow the instructions for code use that are supplied by the code set owner.

4 ABA Routing Number

SIMPLE DATA ELEMENT/CODE REFERENCES

20, 66/13, 506/01, 647/806

SOURCE

Key to American Bankers Association Routing Numbers

AVAILABLE FROM

Rand McNally & Company

P. O. Box 7600

Chicago, IL 60680

ABSTRACT

Contains the Federal Reserve Routing Codes. The first four digits identify the Federal Reserve District, the next four the institution, and the last is a check digit.

5 Countries, Currencies and Funds

SIMPLE DATA ELEMENT/CODE REFERENCES

26, 100, 1715, 66/38, 235/CH, 235/HA, 235/HB, 955/SP

SOURCE

Codes for Representation of Names of Countries, ISO 3166-(Latest Release)

Codes for Representation of Currencies and Funds, ISO 4217-(Latest Release)

AVAILABLE FROM

American National Standards Institute

25 West 43rd Street, 4th Floor

New York, NY 10036

ABSTRACT

Part 1 (Country codes) of the ISO 3166 international standard establishes codes that represent the current names of countries, dependencies, and other areas of special geopolitical interest, on the basis of lists of country names obtained from the United Nations. Part 2 (Country subdivision codes) establishes a code that represents the names of the principal administrative divisions, or similar areas, of the countries, etc. included in Part 1. Part 3 (Codes for formerly used names of countries) establishes a code that represents non-current country names, i.e., the country names deleted from ISO 3166 since its first publication in 1974. Most currencies are those of the geopolitical entities that are listed in ISO 3166 Part 1, Codes for the Representation of Names of Countries. The code may be a three-character alphabetic or three-digit numeric. The two leftmost characters of the alphabetic code identify the currency authority to which the code is assigned (using the two character alphabetic code from ISO 3166 Part 1, if applicable). The rightmost character is a mnemonic derived from the name of the major currency unit or fund. For currencies not associated with a single geographic entity, a specially-allocated two-character alphabetic code, in the range XA to XZ identifies the currency authority. The rightmost character is derived from the name of the geographic area concerned, and is mnemonic to the extent possible. The numeric codes are identical to those assigned to the geographic entities listed in ISO 3166 Part 1. The range 950-998 is reserved for identification of funds and currencies not associated with a single entity listed in ISO 3166 Part 1.

22 States and Provinces

SIMPLE DATA ELEMENT/CODE REFERENCES

156, 66/SJ, 128/PCJ, 128/SOJ, 235/A5, 771/009

SOURCE

U.S. Postal Service or

Canada Post or

Bureau of Transportation Statistics

AVAILABLE FROM

The U.S. state codes may be obtained from:

U.S. Postal Service

National Information Data Center

P.O. Box 2977

Washington, DC 20013

www.usps.gov

The Canadian province codes may be obtained from:

http://www.canadapost.ca

The Mexican state codes may be obtained from:

www.bts.gov/ntda/tbscd/mex-states.html

ABSTRACT

Provides names, abbreviations, and two character codes for the states, provinces and sub-country divisions as defined by the appropriate government agency of the United States, Canada, and Mexico.

51 ZIP Code

SIMPLE DATA ELEMENT/CODE REFERENCES

116, 66/16, 309/PQ, 309/PR, 309/PS, 771/010

SOURCE

National ZIP Code and Post Office Directory, Publication 65

The USPS Domestic Mail Manual

AVAILABLE FROM

U.S Postal Service

Washington, DC 20260

New Orders

Superintendent of Documents

P.O. Box 371954

Pittsburgh, PA 15250-7954

ABSTRACT

The ZIP Code is a geographic identifier of areas within the United States and its territories for purposes of expediting mail distribution by the U.S. Postal Service. It is five or nine numeric digits. The ZIP Code structure divides the U.S. into ten large groups of states. The leftmost digit identifies one of these groups. The next two digits identify a smaller geographic area within the large group. The two rightmost digits identify a local delivery area. In the nine-digit ZIP Code, the four digits that follow the hyphen further subdivide the delivery area. The two leftmost digits identify a sector which may consist of several large buildings, blocks or groups of streets. The rightmost digits divide the sector into segments such as a street, a block, a floor of a building, or a cluster of mailboxes. The USPS Domestics Mail Manual includes information on the use of the new 11-digit zip code.

60 (DFI) Identification Number

SIMPLE DATA ELEMENT/CODE REFERENCES

507

SOURCE

a) Thompson Bank Directory: American Bankers Association (ABA) Routing Numbers

b) New York Clearinghouse Association: Clearinghouse Interbank Payment System (CHIPS) Participant Numbers

c) Canadian Payments Association Directory: Canadian Bank Transit Numbers

d) ISO/S.W.I.F.T. Bank Identifier Code Directory: ISO Bank Identifier Codes

AVAILABLE FROM

a) Thompson Financial Publishing

P.O. Box 65

Skokie, IL 60076-0065

b) New York Clearinghouse Association

450 West 33rd Street

New York, New York 10001

c) Bowne of Toronto

60 Gervais Drive

Toronto, Ontario

Canada M3C 1Z3

d) S.W.I.F.T. SC

Avenue Adele 1

B-1310 La Hulpe

Belgium

ABSTRACT

Assigned alphanumeric codes identifying depository financial institution.

91 Canadian Financial Institution Branch and Institution Number

SIMPLE DATA ELEMENT/CODE REFERENCES

66/CF, 128/04, 506/04, 647/806

SOURCE

Canadian Payments Association (CPA) Financial Institution Directories

Volume 1 - Banks

Volume 2 - Credit Unions and Caisses PopulairesVolume 3 - Trust Companies, Loan Companies and other Deposit-taking Institutions

AVAILABLE FROM

Bowne of Canada, Ltd.

60 Gervais Drive

Toronto, Ontario M3C 1Z3

Canada

ABSTRACT

Contains the Canadian financial institutions transit and branch numbers. The first four digits represent the financial institution ID.

121 Health Industry Number

SIMPLE DATA ELEMENT/CODE REFERENCES

66/21, 128/HI, 1270/HI, I05/20

SOURCE

Health Industry Number Database

AVAILABLE FROM

Health Industry Business Communications Council

5110 North 40th Street

Phoenix, AZ 85018

ABSTRACT

The HIN is a coding system, developed and administered by the Health Industry Business Communications Council, that assigns a unique code number to hospitals other provider organizations, and manufacturers and distributors.

130 Healthcare Common Procedure Coding System

SIMPLE DATA ELEMENT/CODE REFERENCES

235/HC, 1270/BO, 1270/BP

SOURCE

Healthcare Common Procedure Coding System

AVAILABLE FROM

Centers for Medicare & Medicaid Services (CMS)

7500 Security Boulevard

Baltimore, MD 21244

ABSTRACT

HCPCS is Centers for Medicare & Medicaid Services (CMS) coding scheme to group procedures performed for payment to providers.

132 National Uniform Billing Committee (NUBC) Codes

SIMPLE DATA ELEMENT/CODE REFERENCES

235/NU, 235/RB, 1270/BE, 1270/BG, 1270/BH, 1270/BI, 1270/NUB

SOURCE

National Uniform Billing Data Element Specifications

AVAILABLE FROM

National Uniform Billing Committee

American Hospital Association

One North Franklin

Chicago, IL 60606

ABSTRACT

Revenue codes are a classification of hospital charges in a standard grouping that is controlled by the National Uniform Billing Committee.

135 American Dental Association

SIMPLE DATA ELEMENT/CODE REFERENCES

1361, 235/AD, 1270/JO, 1270/JP, 1270/TQ, 1270/AAY

SOURCE

Current Dental Terminology (CDT) Manual

AVAILABLE FROM

Salable Materials

American Dental Association

211 East Chicago Avenue

Chicago, IL 60611-2678

ABSTRACT

The CDT manual contains the American Dental Association's codes for dental procedures and nomenclature and is the accepted set of numeric codes and descriptive terms for reporting dental treatments and descriptors.

139 Claim Adjustment Reason Code

SIMPLE DATA ELEMENT/CODE REFERENCES

1034

SOURCE

National Health Care Claim Payment/Advice Committee Bulletins

AVAILABLE FROM

Blue Cross and Blue Shield Association

Health Information Technology Department

225 N Michigan Avenue

Chicago, IL 60601-7680

ABSTRACT

Bulletins describe standard codes and messages that detail the reason why an adjustment was made to a health care claim payment by the payer.

229 Diagnosis Related Group Number (DRG)

SIMPLE DATA ELEMENT/CODE REFERENCES

1354, 1270/DR

SOURCE

Federal Register and Health Insurance Manual 15 (HIM 15)

AVAILABLE FROM

Superintendent of Documents

U.S. Government Printing Office

Washington, DC 20402

ABSTRACT

A patient classification scheme that clusters patients into categories on the basis of patient's illness, diseases, and medical problems.

235 Claim Frequency Type Code

SIMPLE DATA ELEMENT/CODE REFERENCES

1325

SOURCE

National Uniform Billing Data Element Specifications Type of Bill Last Position

AVAILABLE FROM

National Uniform Billing Committee

American Hospital Association

One North Franklin

Chicago, IL 60606

ABSTRACT

A variety of codes explaining the frequency of different Types of Bills (for example, Replacement Claims).

240 National Drug Code by Format

SIMPLE DATA ELEMENT/CODE REFERENCES

235/N1, 235/N2, 235/N3, 235/N4, 235/N5, 235/N6, 1270/NDC

SOURCE

Drug Establishment Registration and Listing Instruction Booklet

AVAILABLE FROM

Federal Drug Listing Branch HFN-315

5600 Fishers Lane

Rockville, MD 20857

ABSTRACT

Publication includes manufacturing and labeling information as well as drug packaging sizes.

245 National Association of Insurance Commissioners (NAIC) Code

SIMPLE DATA ELEMENT/CODE REFERENCES

128/NF

SOURCE

National Association of Insurance Commissioners Company Code List Manual

AVAILABLE FROM

National Association of Insurance Commission Publications Department

12th Street, Suite 1100

Kansas City, MO 64105-1925

ABSTRACT

Codes that uniquely identify each insurance company.

307 National Council for Prescription Drug Programs Pharmacy Number

SIMPLE DATA ELEMENT/CODE REFERENCES

128/D3

SOURCE

National Council for Prescription Drug Programs (NCPDP) Provider Number Database and Listing

AVAILABLE FROM

National Council for Prescription Drug Programs (NCPDP)

9240 East Raintree Drive

Scottsdale, AZ 85260

ABSTRACT

A unique number assigned in the U.S. and its territories to individual clinic, hospital, chain, and independent pharmacy and dispensing physician locations that conduct business by billing third-party and dispensing physician locations that conduct business by billing third-party drug benefit payers. The National Council for Prescription Drug Programs (NCPDP) maintains this database. The NCPDP Provider Number is a seven-digit number with the following format SSNNNNC, where SS=NCPDP assigned state code number, NNNN=sequential numbering scheme assigned to pharmacy locations, and C=check digit caluculate by algorithm from previous six digits.

411 Remittance Advice Remark Code

SIMPLE DATA ELEMENT/CODE REFERENCES

1270/HE

SOURCE

Centers for Medicare & Medicaid Services

OIS/BSOG/DDIS, Mail Stop N2-13-16

7500 Security Boulevard

Baltimore MD 21244

AVAILABLE FROM

Washington Publishing Company http://www.wpc-edi.com

ABSTRACT

Remittance Advice Remark Codes (RARC) are used to convey information about claim adjudication. It could provide general information or supplemental explanations to an adjustment already reported by a Claim Adjustment Reason Code.

468 Ambulatory Payment Classification

SIMPLE DATA ELEMENT/CODE REFERENCES

128/APC

SOURCE

Ambulatory Payment Classification Manual

AVAILABLE FROM

Centers for Medicare & Medicaid Services

Division of Outpatient Care

7500 Security Boulevard

Baltimore, MD 21244

ABSTRACT

Under the outpatient prospective payment system (OPPS), Medicare pays for hospital outpatient services on a rate per service basis that varies according to the ambulatory payment classification group to which the service is assigned.

475 Ambulatory Patient Groups (APG)

SIMPLE DATA ELEMENT/CODE REFERENCES

1270/AX

SOURCE

Ambulatory Patient Groups (APG) Definition Manual

AVAILABLE FROM

3M Health Information System

575 West Murray Blvd.

P.O. Box 57900

Murray, UT 84157-9900

ABSTRACT

An ambulatory patient classification scheme that groups patients into categories on the basis of the patient's illness, disease(s), medical problems and procedures performed.

476 All Patient Diagnosis Related Groups (AP-DRG)

SIMPLE DATA ELEMENT/CODE REFERENCES

1270/AW

SOURCE

All Patient Diagnosis Related Groups (AP-DRG) Definitions Manual

AVAILABLE FROM

3M Health Information Systems

575 West Murray Blvd.

P.O. Box 57900

Murray, UT 84157-9900

ABSTRACT

An inpatient patient classification scheme that groups patients into categories on the basis of the patient's illness, disease(s) and medical problems.

477 All Patient Refined Diagnosis Related Groups (APR-DRG)

SIMPLE DATA ELEMENT/CODE REFERENCES

1270/AU

SOURCE

All Patient Refined Diagnosis Related Groups Definitions Manual

AVAILABLE FROM

3M Health Information Systems

57900 West Murray Blvd.

P.O. Box 57900

Murray, UT 84157-9900

ABSTRACT

An inpatient patient classification scheme that groups patients into categories on the basis of the patient's illness, disease(s), medical problems and further refines the categories based on resource utilization.

530 National Council for Prescription Drug Programs Reject Codes

SIMPLE DATA ELEMENT/CODE REFERENCES

1270/RX

SOURCE

National Council for Prescription Drug Programs Data Dictionary

AVAILABLE FROM

NCPDP

9240 East Raintree Drive

Scottsdale, AZ 85260

ABSTRACT

A listing of NCPDPs reject reason codes, the explanation of the code, and the field number in error.

537 National Provider Identifier (NPI)

SIMPLE DATA ELEMENT/CODE REFERENCES

66/XX, 128/HPI

SOURCE

National Plan and Provider Enumeration System (NPPES)

AVAILABLE FROM

NPI Enumerator

P.O. Box 6059

Fargo, ND 58108-6059

ABSTRACT

The National Provider Identifier (NPI) refers to the standard unique health identifier for health care providers in 45 CFR 162 Subpart D.

540 Health Plan Identifier (HPID)

SIMPLE DATA ELEMENT/CODE REFERENCES

66/OE, 66/XV, 128/ABY, 128/OEI

SOURCE

Health Plan and Other Entity Enumeration System (HPOES) housed within CMSҠHealth Insurance Oversight System (HIOS)

AVAILABLE FROM

Centers for Medicare & Medicaid Services

7500 Security Boulevard

Baltimore, MD 21244

ABSTRACT

The Centers for Medicare and Medicaid Services has joined with other payers to develop a unique national provider identifier. The Centers for Medicare and Medicaid Services is the authorizing agent for enumerating payers through the services of a PlanID Registrar. It may also be used by other payers on a voluntary basis.

576 Workers Compensation Specific Procedure and Supply Codes

SIMPLE DATA ELEMENT/CODE REFERENCES

235/ER

SOURCE

IAIABC Jurisdiction Medical Bill Report Implementation Guide

AVAILABLE FROM

IAIABC EDI Implementation Manager

International Association of Industrial Accident Boards and Commissions

8643 Hauses - Suite 200

87th Parkway

Shawnee Mission, KS 66215

ABSTRACT

The IAIABC Jurisdiction Medical Bill Report Implementation Guide describes the requirements for submitting and the data contained within a jurisdiction medical report. The Implementation Guide includes: Reporting scenarios, data definitions, trading partner requirements tables, reference to industry codes, and IAIABC maintained code lists.

716 Health Insurance Prospective Payment System (HIPPS) Rate Code

SIMPLE DATA ELEMENT/CODE REFERENCES

235/HP

SOURCE

Health Insurance Prospective Payment System (HIPPS) Rate Code

AVAILABLE FROM

Division of Institutional Claims Processing

Centers for Medicare & Medicaid Services

C4-10-07

7500 Security Boulevard

Baltimore, MD 21244-1850

ABSTRACT

The Centers for Medicare & Medicaid Services develops and publishes the HIPPS codes to establish a coding system for claims submission and claims payment under prospective payment systems. These codes represent the case mix classification groups that are used to determine payment rates under prospective payment systems. Case mix classification groups include, but may not be limited to , resource utilization groups (RUGs) for skilled nursing facilities, home health resource groups (HHRGs) for home health agencies, and case mix groups (CMGs) for inpatient rehabilitation facilities.

843 Advanced Billing Concepts (ABC) Codes

SIMPLE DATA ELEMENT/CODE REFERENCES

235/WK, 1270/CAH

SOURCE

The CAM and Nursing Coding Manual

AVAILABLE FROM

Alternative Link

6121 Indian School Road NE

Suite 131

Albuquerque, NM 87110

ABSTRACT

The manual contains the Advanced Billing Concepts (ABC) codes, descriptive terms and identifiers for reporting complementary or alternative medicine, nursing, and other integrative health care procedures.

932 Universal Postal Codes

SIMPLE DATA ELEMENT/CODE REFERENCES

116

SOURCE

Universal Postal Union website

AVAILABLE FROM

International Bureau of the Universal Postal Union

POST*CODE

Case postale 13

3000 BERNE 15 Switzerland

ABSTRACT

The postcode is the fundamental, essential element of an address. A unique, universal identifier, it unambiguously identifies the addressee's locality and assists in the transmission and sorting of mail items. At present, 105 UPU member countries use postcodes as part of their addressing systems.

944 Source of Payment Typology

SIMPLE DATA ELEMENT/CODE REFERENCES

1732

SOURCE

Source of Payment Typology

AVAILABLE FROM

Payer Type Committee

Public Health Data Standards Consortium

c/o John Hopkins Bloomberg School of Public Health

624 N. Broadway, Room 382

Baltimore, MD 21205

ABSTRACT

A code identifying payer types in the most granular way.

973 Insurance Industry Specific Remark Codes

SIMPLE DATA ELEMENT/CODE REFERENCES

1270/RM

SOURCE

Insurance Industry Specific Remark Codes List

AVAILABLE FROM

ASC X12

201 East Fourth Street, Suite 202

Frederick, MD 2170

ABSTRACT

The code set represents a list of Industry Specific Remark Codes that will be used to supplement the Claim Adjustment Reason Codes.

974 Claim Adjustment Group Codes

SIMPLE DATA ELEMENT/CODE REFERENCES

1785

SOURCE

Claim Adjustment Group Code

AVAILABLE FROM

ASC X12

201 East Fourth Street, Suite 202

Frederick, MD 2170

ABSTRACT

The code set represents the list of group codes that supplement the adjustment reason codes and remark codes.

980 Enhanced Ambulatory Patient Groups

SIMPLE DATA ELEMENT/CODE REFERENCES

1270/EP

SOURCE

3M(tm) Enhanced Ambulatory Patient Grouping Systems Definitions Manual

AVAILABLE FROM

3M Health Information Systems

575 W. Murray Boulevard

Murray UT 84123

ABSTRACT

Definitions manual provides: - An in-depth description of the EAPG classification system logic and structure - Listing of the Enhanced Ambulatory Patient Groups - Background information and some discussion of the development process